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

Individual provider Registered Dietitian · NPI 1053988477

Jordan Domenick, RD is a Registered Dietitian in Fort Stewart, Georgia. Practices as a sole proprietor. Licensed in Minnesota and Missouri.

Licensed in
MN, MO
In the registry since
2021
Specialties on file
2
What do these letters mean?
RD — Registered Dietitian
A credentialed nutrition professional.

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Practice location Address checks out

1061 Harmon Ave
Fort Stewart, GA 31314-5641
Phone: (912) 435-6633
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Registered Dietitian (primary) Taxonomy 133V00000X · Licence 2022036290 (MO)
Registered Dietitian Taxonomy 133V00000X · Licence 4237 (MN)

Record details

NPI number1053988477
Entity typeIndividual (Type 1)
GenderMale
Credentials RD
Sole proprietorYes
NPI enumeratedJune 4, 2021
Last updated in NPPESDecember 28, 2023
Certification dateDecember 28, 2023
Mailing address1061 Harmon Ave, Fort Stewart, GA 31314-5641

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