NPIMap

Organization Active NPI

Jessica Byrd White LLC

  • Registered Dietitian
  • Dothan, AL
National Provider Identifier
1891332904
Registry record updated Apr 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
Legal business name
JESSICA BYRD WHITE LLC
Practice address
3113 Wesley Way Ste 2
Dothan, AL 36305-2004
Phone
(334) 245-8810
NPI assigned
Dec 8, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2020

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

Authorized official

Name
Jessica Byrd White, RDNNPI 1578955449
Title
Owner
Phone
(334) 791-0314

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193400000X SINGLE SPECIALTY GROUP 133V00000X Primary

Addresses

Primary practice location

3113 Wesley Way Ste 2
Dothan, AL 36305-2004

Mailing address

407 Forsythia LN
Dothan, AL 36305-5904
Phone (334) 791-0314

Other practice location 1

1676 Montgomery Hwy
Dothan, AL 36303-3344
Phone (334) 791-0314

Other practice location 2

407 Forsythia Ln
Dothan, AL 36305-5904
Phone (334) 791-0314

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200404000005 AL Part B Supplier - Clinic/Group Practice 1759710254 Receives reassigned benefits from 3 practitioners
Practice locations: Dothan, AL

National Provider Directory

National Provider Directory

Locations

1825 W Main St
Dothan, AL 36301
Phone (334) 699-8175

1676 Montgomery Hwy
Dothan, AL 36303
Phone (334) 791-0314

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1575763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585872000000",
    "number": "1891332904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 FORSYTHIA LN",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363055904",
            "telephone_number": "334-791-0314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3113 WESLEY WAY STE 2",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363052004",
            "telephone_number": "334-245-8810"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1676 Montgomery Hwy",
            "address_purpose": "LOCATION",
            "city": "Dothan",
            "state": "AL",
            "postal_code": "363033344",
            "country_code": "US",
            "telephone_number": "334-791-0314",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "407 Forsythia Ln",
            "address_purpose": "LOCATION",
            "city": "Dothan",
            "state": "AL",
            "postal_code": "363055904",
            "country_code": "US",
            "telephone_number": "334-791-0314",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JESSICA BYRD WHITE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-08",
        "last_updated": "2020-04-03",
        "certification_date": "2020-04-03",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "BYRD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "334-791-0314",
        "authorized_official_credential": "RDN"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dothan, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.