Active NPI
Jonathan S Shane, FNTP
- Nutrition Education Nutritionist
- Katy, TX
National Provider Identifier
1710588686
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutrition Education Nutritionist
- License
- 5275
- Practice address
- 3038 Village Creek Dr
Katy, TX 77494-6950 - Phone
- (832) 285-6739
- NPI assigned
- Nov 5, 2020
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Nutrition Education Nutritionist | 133NN1002X | 5275 | TX | Primary |
Addresses
Primary practice location
3038 Village Creek Dr
Katy, TX 77494-6950
Mailing address
3038 Village Creek Dr
Katy, TX 77494-6950
Phone (832) 285-6739
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5275 | TX | MD | Nutrition Education Nutritionist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604534400000",
"number": "1710588686",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3038 VILLAGE CREEK DR",
"city": "KATY",
"state": "TX",
"postal_code": "774946950",
"telephone_number": "832-285-6739"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3038 VILLAGE CREEK DR",
"city": "KATY",
"state": "TX",
"postal_code": "774946950",
"telephone_number": "832-285-6739"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHANE",
"first_name": "JONATHAN",
"middle_name": "S",
"name_prefix": "Mr.",
"credential": "FNTP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-11-05",
"last_updated": "2020-11-05",
"certification_date": "2020-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "133NN1002X",
"taxonomy_group": "",
"desc": "Nutritionist, Nutrition, Education",
"state": "TX",
"license": "5275",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Katy, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.