NPI 1083577886 · live from the CMS NPI Registry
Jessica Susan Butler, RDN, LD
Dietitian, Registered in Fort Wayne, IN. National Provider Identifier 1083577886, active.
NPI record
| NPI | 1083577886 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dietitian, Registered 133V00000X |
| Practice location | 2121 Lake Ave, Fort Wayne, IN 46805 |
| Practice phone | 260-426-2097 |
| Mailing address | 7111 Garman Rd, Auburn, IN 46706 |
| Enumerated | December 8, 2025 |
| Last updated | December 8, 2025 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dietitian, Registered primary | 133V00000X | 37003025A (IN) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.