Active NPI
Tyree Williams Sr., RDN, LD/N
- Registered Dietitian
- Jacksonville, FL
National Provider Identifier
1912431545
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- ND 6743
- Practice address
- 10757 Meadow Lea Dr
Jacksonville, FL 32218-4503 - Phone
- (904) 707-0505
- NPI assigned
- Apr 20, 2017
- Sex
- Male
- 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 | ND 6743 | FL | Primary |
Addresses
Primary practice location
10757 Meadow Lea Dr
Jacksonville, FL 32218-4503
Mailing address
10757 Meadow Lea Dr
Jacksonville, FL 32218-4503
Phone (904) 707-0505
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ND 6743 | FL | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1492646400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1492646400000",
"number": "1912431545",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10757 MEADOW LEA DR",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322184503",
"telephone_number": "904-707-0505"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10757 MEADOW LEA DR",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322184503",
"telephone_number": "904-707-0505"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "TYREE",
"name_prefix": "Mr.",
"name_suffix": "Sr.",
"credential": "RDN, LD/N",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-04-20",
"last_updated": "2017-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "FL",
"license": "ND 6743",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.