Healthcare Provider Details

I. General information

NPI: 1629412820
Provider Name (Legal Business Name): DEBORAH D JONGKIND R.D., L.D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 VINEYARD MIST DR
CARY NC
27519-6998
US

IV. Provider business mailing address

1630 VINEYARD MIST DR
CARY NC
27519-6998
US

V. Phone/Fax

Practice location:
  • Phone: 919-225-3779
  • Fax:
Mailing address:
  • Phone: 919-225-3779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL000516
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: