Active NPI
Jennifer Raykovich, RDN
- Registered Dietitian
- Clarkston, WA
National Provider Identifier
1831542331
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DI 60335514
- Practice address
- 1221 Highland Ave
Clarkston, WA 99403-2829 - Phone
- (509) 758-5511
- Fax
- (509) 758-9223
- NPI assigned
- Jul 20, 2016
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | D-627 | ID | |
| Registered Dietitian | 133V00000X | DI 60335514 | ID | Primary |
Addresses
Primary practice location
1221 Highland Ave
Clarkston, WA 99403-2829
Mailing address
PO Box 189
1221 Highland Ave
Clarkston, WA 99403
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D-627 | ID | MD | Registered Dietitian |
| DI 60335514 | ID | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1468972800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1468972800000",
"number": "1831542331",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 189",
"address_2": "1221 HIGHLAND AVE",
"city": "CLARKSTON",
"state": "WA",
"postal_code": "99403"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1221 HIGHLAND AVE",
"city": "CLARKSTON",
"state": "WA",
"postal_code": "994032829",
"telephone_number": "509-758-5511",
"fax_number": "509-758-9223"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAYKOVICH",
"first_name": "JENNIFER",
"credential": "RDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-07-20",
"last_updated": "2016-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "ID",
"license": "D-627",
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "ID",
"license": "DI 60335514",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clarkston, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.