Active NPI
Kevin Jackson
- Registered Dietitian
- Chillicothe, OH
National Provider Identifier
1992932404
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- Practice address
- 17273 State Route 104
Chillicothe, OH 45601-9718 - Phone
- (740) 773-1141
- NPI assigned
- Jun 11, 2009
- Sex
- Male
- 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 | OH | Primary |
Addresses
Primary practice location
17273 State Route 104
Chillicothe, OH 45601-9718
Mailing address
5615 Pleasant Valley Rd SW
Lancaster, OH 43130-8916
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1244678400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1244678400000",
"number": "1992932404",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5615 PLEASANT VALLEY RD SW",
"city": "LANCASTER",
"state": "OH",
"postal_code": "431308916"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17273 STATE ROUTE 104",
"city": "CHILLICOTHE",
"state": "OH",
"postal_code": "456019718",
"telephone_number": "740-773-1141"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "KEVIN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-06-11",
"last_updated": "2009-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "OH",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chillicothe, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.