Jessica Ellen Black, MS, NC

Primary specialty

NutritionistTaxonomy code 133N00000X

Practice address

1239 Liberty St Apt 225
El Cerrito, CA 94530-2347

Phone

(510) 705-2680

NPI assigned

Sep 22, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

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

{
    "created_epoch": "1600732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600732800000",
    "number": "1992311120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1239 LIBERTY ST APT 225",
            "city": "EL CERRITO",
            "state": "CA",
            "postal_code": "945302347",
            "telephone_number": "510-705-2680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1239 LIBERTY ST APT 225",
            "city": "EL CERRITO",
            "state": "CA",
            "postal_code": "945302347",
            "telephone_number": "510-705-2680"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1485 Solano Ave",
            "address_purpose": "LOCATION",
            "city": "Albany",
            "state": "CA",
            "postal_code": "947062147",
            "country_code": "US",
            "telephone_number": "510-705-2680",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACK",
        "first_name": "JESSICA",
        "middle_name": "ELLEN",
        "credential": "MS, NC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-22",
        "last_updated": "2020-09-22",
        "certification_date": "2020-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "simplepractice.com",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "simplepractice.com",
            "address_1": "1239 Liberty St Apt 225",
            "city": "El Cerrito",
            "state": "CA",
            "country_code": "US",
            "postal_code": "945302347",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Connor Benefield
• Julia Bernard
• Varinder Singh Bhatia
• Anna Billings, LMFT
• January Rita Bishop, ED.D; M.S.W.
• Elizabeth Trusler Block
• Kathleen Bohrer, PH.D BCBA-D
• Rosemarie M Bowler
• Danielle Elizabeth Boyer, P.T.
• Dejana Nashae Jackulline Bracey

• Nutritionist in El Cerrito, CA
• Providers in El Cerrito, CA by specialty
• Nutritionist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 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.