Jenna Nicole Brannock, RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

966688 Issued in IN

Practice address

2360 E Pershing Blvd
Cheyenne, WY 82001-5356

Phone

(307) 778-7550

NPI assigned

Aug 4, 2008

Last updated

Oct 8, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1217808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570492800000",
    "number": "1750547295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2360 E PERSHING BLVD",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820015356",
            "telephone_number": "307-778-7550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2360 E PERSHING BLVD",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820015356",
            "telephone_number": "307-778-7550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRANNOCK",
        "first_name": "JENNA",
        "middle_name": "NICOLE",
        "credential": "RD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-08-04",
        "last_updated": "2019-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IN",
            "license": "966688",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "jenna.brannock@va.gov",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "2360 E Pershing Blvd",
            "city": "Cheyenne",
            "state": "WY",
            "country_code": "US",
            "postal_code": "820015356",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Registered Dietitian in Cheyenne, WY
• Providers in Cheyenne, WY by specialty
• Registered Dietitian in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.