MS. JACKIE SUE SHANK (NPI# 1427178425) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427178425 |
| Entity Type | Individual |
| Full Name | MS. JACKIE SUE SHANK |
| Credential | R.D. |
| Practice Address |
401 Porpoise Point Dr St Augustine FL 32084-2959 |
| Practice Telephone | 9048264307 |
| Mailing Telephone | 9048264307 |
| Enumeration Date | 2007-03-31 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 133V00000X | Dietitian, Registered | ND812 | FL | Dietary & Nutritional Service Providers |
| Street Address |
401 PORPOISE POINT DR |
| City | ST AUGUSTINE |
| State | FL |
| Zip Code | 32084-2959 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295347599 | Cody Martyn | Pharmacist | 955 Fl-16, St. Augustine, FL 32084 | 2020-08-18 |
| 1912562471 | Kjcares Suportive Living Services | Case Manager/Care Coordinator | 20 First Street, Apt 5, St. Augustine, FL 32084 | 2019-05-09 |
| 1558841684 | Kevin D Roberts | Psychologist | 20 First Street Apt 5, St. Augustine, FL 32084 | 2018-08-17 |
| 1568954576 | Gwendolyn Marie Spong | Nurse Practitioner | 2703 N Ponce De Leon Blvd., Minute Clinic #3591, Area 4, Region 46, St. Augustine, FL 32084 | 2018-06-05 |
| 1770940116 | Marian L. Turner-sharpton, Lcsw | Social Worker | 17 Pacific St., Suite 2 (growth Pointe), St. Augustine, FL 32084 | 2016-01-15 |
| 1710358932 | Florida Laboratory Analysis, LLC | Clinical Medical Laboratory | 1690 Us Highway 1 S Ste D, St Augustine, FL 32084 | 2015-10-14 |
| 1780064774 | J Mae Transportation | Non-emergency Medical Transport (VAN) | 28 N Whitney St Apt 404, St Augustine, FL 32084 | 2015-06-04 |
| 1497154520 | Suzanne Smith Weed | Nurse Practitioner | 32 Mulberry Street, Saint Augustine, FL 32084 | 2014-08-14 |
| 1447684469 | Rachel Moran | Counselor | 162 Oneida Street, St. Augustine, FL 32084 | 2013-08-27 |
| 1932545993 | Matrix Medical, LLC | Durable Medical Equipment & Medical Supplies | 56 S Dixie Hwy Ste 1, St Augustine, FL 32084 | 2013-05-17 |
| Find all providers in zip 32084 | ||||
| Taxonomy Code | 133V00000X |
| Grouping | Dietary & Nutritional Service Providers |
| Classification | Dietitian, Registered |
| A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor’s degree at a US regionally accredited university or college and course work approved by The American Dietetic Association (ADA); an ADA-accredited or approved, supervised practice program, typically 6 to 12 months in length; a national examination administered by the Commission on Dietetic Registration; and continuing professional educational requirements to maintain registration. |
| Notes: Source: The American Dietetic Association. Becoming a Registered Dietitian – a food and nutrition expert. Chicago, IL: The American Dietetic Association, July 1997. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063061752 | Christine Laila Vega | Dietitian, Registered | 291 Pickett Dr, St Augustine, FL 32084-6648 | 2019-09-05 |
| 1598011314 | Amanda Quigley Perrin | Dietitian, Registered | 2820 Us 1 S, Ste J, St Augustine, FL 32086-6311 | 2012-07-30 |
| 1083659056 | Carolyn K. Messer | Dietitian, Registered | 2413 Kacie Ln, St Augustine, FL 32084-8258 | 2006-06-16 |
| 1922054154 | Lisa Margaret Hall | Dietitian, Registered | 64 Miruela Ave, St Augustine, FL 32080-3864 | 2006-05-26 |
| 1831741925 | Jessica Anne Lindamood | Dietitian, Registered | 400 Health Park Blvd, St Augustine, FL 32086-5790 | 2019-07-10 |
| 1295275691 | Devyn K. Chadwell | Dietitian, Registered | 400 Health Park Blvd, St Augustine, FL 32086-5784 | 2017-03-03 |
| 1528502937 | Kayla Lee Vosburgh | Dietitian, Registered | 400 Health Park Blvd, St Augustine, FL 32086-5784 | 2016-12-05 |
| 1306228952 | Elizabeth Outlaw Muchmore | Dietitian, Registered | 400 Health Park Blvd, Flagler Hospital, St Augustine, FL 32086 | 2015-06-19 |
| 1992182786 | Betty Willis | Dietitian, Registered | 400 Health Park Blvd, St Augustine, FL 32086-5784 | 2015-04-30 |
| 1144422700 | Katherine M Jennison | Dietitian, Registered | 400 Health Park Blvd, St Augustine, FL 32086-5784 | 2007-06-04 |
| Find all providers in ST AUGUSTINE | ||||
| City | ST AUGUSTINE |
| Zip Code | 32084 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.