Provider Demographics
NPI:1447147426
Name:JESTIC, CHARLA (MNT, MBCE)
Entity type:Individual
Prefix:
First Name:CHARLA
Middle Name:
Last Name:JESTIC
Suffix:
Gender:F
Credentials:MNT, MBCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4860 GOLDEN VALLEY TRL
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-8641
Mailing Address - Country:US
Mailing Address - Phone:636-544-1604
Mailing Address - Fax:
Practice Address - Street 1:4860 GOLDEN VALLEY TRL
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-8641
Practice Address - Country:US
Practice Address - Phone:636-544-1604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-21
Last Update Date:2025-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist