JONATHAN SHANE CLACK (NPI# 1801230685) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801230685 |
| Entity Type | Individual |
| Full Name | JONATHAN SHANE CLACK |
| Credential | MS, RD, LD |
| Practice Address |
805 Terry Trl Weatherford TX 76086-4601 |
| Practice Telephone | 8176290420 |
| Mailing Telephone | 8176290420 |
| Enumeration Date | 2013-04-23 |
| Last Update Date | 2018-06-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 133V00000X | Dietitian, Registered | DT82634 | TX | Dietary & Nutritional Service Providers |
| Street Address |
805 TERRY TRL |
| City | WEATHERFORD |
| State | TX |
| Zip Code | 76086-4601 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538592308 | Bailey Dixon Clack | Dietitian, Registered | 805 Terry Trl, Weatherford, TX 76086-4601 | 2013-08-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104434810 | Beverly Diana Blair | Licensed Vocational Nurse | 870 Columbia Drive, Weatherford, Weatherford, TX 76086 | 2020-07-20 |
| 1275027385 | Star Family Medicine Pllc | Family Medicine | 933 Hilltop Dr Ste 100, Weatherford, TX 76086 | 2018-06-21 |
| 1174011324 | Anuj Yogesh Vyas | Student in an Organized Health Care Education/Training Program | Medical City Weatherford 713 E. Anderson, Weatherford, TX 76086 | 2018-04-24 |
| 1003321068 | Kleven Chiropractic, LLC | Chiropractor | 925 Santa Fe Drive, Suite #111, Weatherford, TX 76086 | 2017-12-12 |
| 1417471467 | Weatherford Health Services, LLC | General Acute Care Hospital | 713 East Anderson Street, Weatherford, TX 76086 | 2017-08-01 |
| 1710401021 | Kyle Evan Meason | Dentist | 2035 Fort Worth Hwy Ste 600, Weatherford, TX 76086 | 2017-07-28 |
| 1457898520 | Apmd LLC | Clinic/Center | 110 W I-20 Frontage Rd, Suite 130, Weatherford, TX 76086 | 2017-01-26 |
| 1861934887 | Laura Neel | Occupational Therapist | 250 Sante Fe Dr, Weatherford, TX 76086 | 2016-11-08 |
| 1588022040 | Heather Goddard | Nurse Practitioner | 920 Sante Fe Drive, Weatherford, TX 76086 | 2016-01-29 |
| 1689049413 | The Dermatology Spot Pllc | Dermatology | 1841 Martin Dr, 200, Weatherford, TX 76086 | 2015-12-04 |
| Find all providers in zip 76086 | ||||
| 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 |
|---|---|---|---|---|
| 1689811333 | Whitney Blair Hopkins I | Dietitian, Registered | 121 Scenic Ridge Dr, Weatherford, TX 76087-1522 | 2009-01-17 |
| 1720432594 | North Texas Nutrition Consultants | Dietitian, Registered | 106 Austin Ave Ste 107, Weatherford, TX 76086-3381 | 2016-04-19 |
| 1538592308 | Bailey Dixon Clack | Dietitian, Registered | 805 Terry Trl, Weatherford, TX 76086-4601 | 2013-08-15 |
| 1891128666 | Clack Nutrition | Dietitian, Registered | 1011 N Main St, Weatherford, TX 76086-2029 | 2013-08-15 |
| 1649507112 | Ashley Phillips | Dietitian, Registered | 713 E Anderson St, Weatherford, TX 76086-5705 | 2009-11-04 |
| 1013125756 | Weatherford Texas Hospital Company LLC | Dietitian, Registered | 713 E Anderson St, Weatherford, TX 76086-5705 | 2007-05-18 |
| 1588729586 | Nancy Stephenson | Dietitian, Registered | 215 N Kansas St, Weatherford, OK 73096-5443 | 2006-12-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952902637 | Allison Kleppe | Dietitian, Registered | 6255 Oram St Apt 106, Dallas, TX 75214-3985 | 2020-11-08 |
| 1326649088 | Mitzie Rojas | Dietitian, Registered | 1805 Aquarena Springs Dr Apt 505, San Marcos, TX 78666-8164 | 2020-11-07 |
| 1912507971 | Wendy Snowden | Dietitian, Registered | 11223 Kingsgate Dr, Austin, TX 78748-3435 | 2020-10-29 |
| 1720687718 | Jordan Wright | Dietitian, Registered | 2900 N Braeswood Blvd Apt 6204, Houston, TX 77025-2367 | 2020-10-20 |
| 1891393062 | Melanie Thomas | Dietitian, Registered | 4722 Pickridge Ct, Fresno, TX 77545-7529 | 2020-10-11 |
| 1073110318 | Mary Elizabeth Santarosa Mahoney | Dietitian, Registered | 1322 Cotulla Dr, Allen, TX 75013-4639 | 2020-10-08 |
| 1104423797 | Mariam Maaz Eid | Dietitian, Registered | 8421 Etienne Cv, Austin, TX 78759-8201 | 2020-10-06 |
| 1518564467 | Elizabeth Hill | Dietitian, Registered | 6500 Champion Grandview Way Apt 22105, Austin, TX 78750-8388 | 2020-10-05 |
| 1215534441 | Maryia Nassonova | Dietitian, Registered | 5740 Airport Fwy, Haltom City, TX 76117-6005 | 2020-10-01 |
| 1366049488 | Ifunanya Onyima | Dietitian, Registered | 2500 Marketplace Dr Apt 536, Waco, TX 76711-2440 | 2020-10-01 |
| Find all providers with the same taxonomy | ||||
| City | WEATHERFORD |
| Zip Code | 76086 |
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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.