Individual provider Active NPI

Jayme A Kukowski

  • Registered Dietitian
  • Fort Myers, FL
National Provider Identifier
1841414356
Registry record updated Mar 22, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
ND4405 Issued in FL
Practice address
13813 Metro Pkwy
Fort Myers, FL 33912-4343
Phone
(239) 936-1343
NPI assigned
Apr 13, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X ND4405 FL Primary

Addresses

Primary practice location

13813 Metro Pkwy
Fort Myers, FL 33912-4343

Mailing address

PO Box 7006
Fort Myers, FL 33911-7006
Phone (239) 931-3440

Other identifiers 1

IdentifierTypeStateIssuer
AE289YOtherFLMEDICARE

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

Practice roles

OrganizationSpecialtyStatusNew patients
Internal Medicine Associates of Lee County MD PA PastSince Aug 1, 2012 Accepting new patients
Internal Medicine Associates of Lee County Hospitalist Group, LLC Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1176422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332374400000",
    "number": "1841414356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7006",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339117006",
            "telephone_number": "239-931-3440",
            "fax_number": "239-931-3454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13813 METRO PKWY",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339124343",
            "telephone_number": "239-936-1343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUKOWSKI",
        "first_name": "JAYME",
        "middle_name": "A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-13",
        "last_updated": "2012-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "FL",
            "license": "ND4405",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "AE289Y",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2012; 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.