NPIMap

Organization Active NPI

Jordan Boucher

  • Registered Dietitian
  • Port Orchard, WA
National Provider Identifier
1942697198
Registry record updated Apr 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
DI 60543717 Issued in WA
Legal business name
JORDAN BOUCHER
Practice address
3333 SE Horstman Rd
Port Orchard, WA 98366-4054
Phone
(713) 689-9673
NPI assigned
Apr 24, 2015
Last updated
Apr 24, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2015

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

Authorized official

Name
Jordan Lynn Boucher, RD
Title
Registered Dietitian
Phone
(713) 689-9673

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X DI 60543717 WA Primary

Addresses

Primary practice location

3333 SE Horstman Rd
Port Orchard, WA 98366-4054

Mailing address

3333 SE Horstman Rd
Port Orchard, WA 98366-4054
Phone (713) 689-9673

Other names 1

  • Lively Greens Other name

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1429833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429833600000",
    "number": "1942697198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 SE HORSTMAN RD",
            "city": "PORT ORCHARD",
            "state": "WA",
            "postal_code": "983664054",
            "telephone_number": "713-689-9673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 SE HORSTMAN RD",
            "city": "PORT ORCHARD",
            "state": "WA",
            "postal_code": "983664054",
            "telephone_number": "713-689-9673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JORDAN BOUCHER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-24",
        "last_updated": "2015-04-24",
        "status": "A",
        "authorized_official_last_name": "BOUCHER",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "REGISTERED DIETITIAN",
        "authorized_official_telephone_number": "713-689-9673",
        "authorized_official_credential": "RD"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "WA",
            "license": "DI 60543717",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lively Greens",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Port Orchard, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2015; 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.