Active NPI
Kim Marie Vagt, MS, RD, CDE
- Registered Dietitian
- Jackson, CA
National Provider Identifier
1720384589
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 013949
- Practice address
- 200 Mission Blvd
Jackson, CA 95642-2564 - Phone
- (209) 223-7430
- Fax
- (209) 257-7634
- NPI assigned
- Jan 26, 2011
- Last updated
- Jan 26, 2011
- Sex
- Female
- Sole proprietor
- Yes
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 | 013949 | CA | Primary |
Addresses
Primary practice location
200 Mission Blvd
Jackson, CA 95642-2564
Mailing address
200 Mission Blvd
Jackson, CA 95642-2564
Phone (209) 223-7430
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 013949 | CA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1296000000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1296000000000",
"number": "1720384589",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 MISSION BLVD",
"city": "JACKSON",
"state": "CA",
"postal_code": "956422564",
"telephone_number": "209-223-7430",
"fax_number": "209-257-7634"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 MISSION BLVD",
"city": "JACKSON",
"state": "CA",
"postal_code": "956422564",
"telephone_number": "209-223-7430",
"fax_number": "209-257-7634"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAGT",
"first_name": "KIM",
"middle_name": "MARIE",
"name_prefix": "Ms.",
"credential": "MS, RD, CDE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-01-26",
"last_updated": "2011-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "013949",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, CA
- Melanie M Trowbridge, MD
- Trumania Inc
- Sharon Thao VI Tu, DMD
- United Home Care of Northern California, LC (United Personal Care Services)
- United Homecare of Northern California, LC (Amador Home Health)
- Lisa G Valdez-Shaw
- Richard Harvey Vanbuskirk, O.D.
- Donald Duane Vanfossan, M.D.
- Mary Michelle Vanfossan, RD
- Jayasree Vasudevan Nair, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.