Active NPI
Kathryn M Jackson, RDN
- Registered Dietitian
- Saint Louis, MO
National Provider Identifier
1700479482
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- Practice address
- 3172 Morganford Rd Apt 208
Saint Louis, MO 63116-1965 - Phone
- (317) 489-2263
- NPI assigned
- Feb 14, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | Primary |
Addresses
Primary practice location
3172 Morganford Rd Apt 208
Saint Louis, MO 63116-1965
Mailing address
3172 Morganford Rd Apt 208
Saint Louis, MO 63116-1965
Phone (317) 489-2263
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Roundtable Wellness | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1613260800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615248000000",
"number": "1700479482",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3172 MORGANFORD RD APT 208",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631161965",
"telephone_number": "317-489-2263"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3172 MORGANFORD RD APT 208",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631161965",
"telephone_number": "317-489-2263"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "KATHRYN",
"middle_name": "M",
"credential": "RDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-02-14",
"last_updated": "2021-03-09",
"certification_date": "2021-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.