Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Intermountain Medical Group, Inc

Organization Registered Dietitian · NPI 1356397673

Intermountain Medical Group, Inc is a Registered Dietitian in Kingston, Pennsylvania. Licensed in Pennsylvania. Registered with an NPI since 2006.

Licensed in
PA
In the registry since
2006
Specialties on file
13
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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Practice location Address checks out

610 Wyoming Ave
Kingston, PA 18704-3702
Phone: (570) 288-5441
Fax: (570) 288-5842
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X
Registered Dietitian Taxonomy 133V00000X
Internal Medicine Physician Taxonomy 207R00000X
Obstetrics & Gynecology Physician Taxonomy 207V00000X
Orthopaedic Surgery Physician Taxonomy 207X00000X
Neurology Physician Taxonomy 2084N0400X
Diagnostic Radiology Physician Taxonomy 2085R0202X
Surgery Physician Taxonomy 208600000X
Urology Physician Taxonomy 208800000X
General Practice Physician Taxonomy 208D00000X
Foot & Ankle Surgery Podiatrist Taxonomy 213ES0103X (PA)
Medical Physician Assistant Taxonomy 363AM0700X
Nurse Practitioner Taxonomy 363L00000X

Record details

NPI number1356397673
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jennifer Jackson — Senior Director Provider Enrollment · (877) 892-9815
NPI enumeratedMay 26, 2006
Last updated in NPPESJanuary 25, 2022
Certification dateJanuary 25, 2022
Mailing address4000 Meridian Blvd, Franklin, TN 37067-6325

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