Active NPI
Alexandra M Jack, RD
- Registered Dietitian
- Vancouver, WA
National Provider Identifier
1972674083
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 560
- Practice address
- 8716 E Mill Plain Blvd
Specialty Clinics Building
Vancouver, WA 98664-2531 - Phone
- (360) 514-7932
- NPI assigned
- Nov 11, 2006
- 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 | 560 | OR | Primary |
Addresses
Primary practice location
8716 E Mill Plain Blvd
Specialty Clinics Building
Vancouver, WA 98664-2531
Mailing address
8716 E Mill Plain Blvd
Specialty Clinics Building
Vancouver, WA 98664-2531
Phone (360) 514-7932
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8404915 | Medicaid | OR |
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 |
|---|---|---|---|
| 560 | OR | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163203200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1381363200000",
"number": "1972674083",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8716 E MILL PLAIN BLVD",
"address_2": "SPECIALTY CLINICS BUILDING",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986642531",
"telephone_number": "360-514-7932"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8716 E MILL PLAIN BLVD",
"address_2": "SPECIALTY CLINICS BUILDING",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986642531",
"telephone_number": "360-514-7932"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACK",
"first_name": "ALEXANDRA",
"middle_name": "M",
"name_prefix": "Mrs.",
"credential": "RD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-11",
"last_updated": "2013-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "OR",
"license": "560",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8404915",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.