Provider Demographics
NPI:1710778998
Name:SCARLETT, JORDAN SCOTT (RDN, LDN)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:SCOTT
Last Name:SCARLETT
Suffix:
Gender:M
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 DOUGLAS DR
Mailing Address - Street 2:
Mailing Address - City:SEDGWICK
Mailing Address - State:KS
Mailing Address - Zip Code:67135-9312
Mailing Address - Country:US
Mailing Address - Phone:316-633-2174
Mailing Address - Fax:
Practice Address - Street 1:1000 DOUGLAS DR
Practice Address - Street 2:
Practice Address - City:SEDGWICK
Practice Address - State:KS
Practice Address - Zip Code:67135-9312
Practice Address - Country:US
Practice Address - Phone:316-633-2174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2775133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered