Provider Demographics
NPI:1548684103
Name:BETTS, JESSICA LEE (MS, RD, LD)
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:LEE
Last Name:BETTS
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 NORWOOD ST
Mailing Address - Street 2:
Mailing Address - City:FAIRWAY
Mailing Address - State:KS
Mailing Address - Zip Code:66205-2647
Mailing Address - Country:US
Mailing Address - Phone:402-630-9304
Mailing Address - Fax:
Practice Address - Street 1:5301 NORWOOD ST
Practice Address - Street 2:
Practice Address - City:FAIRWAY
Practice Address - State:KS
Practice Address - Zip Code:66205-2647
Practice Address - Country:US
Practice Address - Phone:402-630-9304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1598133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered