Active NPI
Jordan Wilson
- Registered Dietitian
- Las Vegas, NV
National Provider Identifier
1962914341
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 39201-DI-0
- Practice address
- 2075 E Flamingo Rd -Southmagna, Room242
Las Vegas, NV 89119-5188 - Phone
- (702) 592-0069
- NPI assigned
- Oct 25, 2017
- Sex
- Female
- Sole proprietor
- No
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 | 39201-DI-0 | NV | Primary |
Addresses
Primary practice location
2075 E Flamingo Rd -Southmagna, Room242
Las Vegas, NV 89119-5188
Mailing address
6070 Burleson Ranch Rd
Las Vegas, NV 89131-3142
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39201-DI-0 | NV | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1508889600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1508889600000",
"number": "1962914341",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6070 BURLESON RANCH RD",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891313142"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2075 E FLAMINGO RD -SOUTHMAGNA, ROOM242",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891195188",
"telephone_number": "702-592-0069"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JORDAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-10-25",
"last_updated": "2017-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NV",
"license": "39201-DI-0",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 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.