Jaclyn Makovich, RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

1189 Issued in SC

Practice address

171 Ashley Ave
Charleston, SC 29425

Phone

(843) 876-4306

NPI assigned

Oct 22, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jaclyn Brisson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1445472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586908800000",
    "number": "1922470566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751461",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751461",
            "telephone_number": "843-792-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "171 ASHLEY AVE",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "29425",
            "telephone_number": "843-876-4306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAKOVICH",
        "first_name": "JACLYN",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-22",
        "last_updated": "2020-04-15",
        "certification_date": "2020-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "SC",
            "license": "1189",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACLYN",
            "last_name": "BRISSON",
            "credential": "RD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kimberly Maino, MD
• Dhruw Maisuria, MD
• John C Maize Jr., MD
• John C Maize Sr., MD
• Qurratulain Majid, LPT
• Andrea Maksimowitz, MSP CCC SLP
• Connor James Malark
• Taylor Malchow, MD
• Nathalie Simone Malcolm
• Rebecca Megan Malcolm, PHARM.D.

• All providers in Charleston, SC
• Registered Dietitian in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2020; 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.