Active NPI
Jennifer Roach
- Registered Dietitian
- Mount Shasta, CA
National Provider Identifier
1972304616
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 819436
- Practice address
- 408 Pine St
Mount Shasta, CA 96067-2126 - Phone
- (530) 926-7196
- NPI assigned
- Mar 20, 2025
- Sex
- Female
- 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 | 819436 | CA | Primary |
Addresses
Primary practice location
408 Pine St
Mount Shasta, CA 96067-2126
Mailing address
408 Pine St
Mount Shasta, CA 96067-2126
Phone (530) 926-7196
Other names 1
- Miss Jennifer Webb
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 |
|---|---|---|---|
| 819436 | CA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1742428800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1750118400000",
"number": "1972304616",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "408 PINE ST",
"city": "MOUNT SHASTA",
"state": "CA",
"postal_code": "960672126",
"telephone_number": "530-926-7196"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "408 PINE ST",
"city": "MOUNT SHASTA",
"state": "CA",
"postal_code": "960672126",
"telephone_number": "530-926-7196"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROACH",
"first_name": "JENNIFER",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-03-20",
"last_updated": "2025-06-17",
"certification_date": "2025-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "819436",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JENNIFER",
"last_name": "WEBB",
"prefix": "MISS",
"credential": "RD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Mount Shasta, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.