Provider Demographics
NPI:1548710965
Name:THOMAS, JESSICA DIANE (RD, LDN)
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:DIANE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 MEDICAL CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28714-9004
Mailing Address - Country:US
Mailing Address - Phone:828-682-1940
Mailing Address - Fax:
Practice Address - Street 1:202 MEDICAL CAMPUS DR
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28714-9004
Practice Address - Country:US
Practice Address - Phone:828-682-1940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004999133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1062088OtherCOMMISSION ON DIETETIC REGISTRATION
NCL004999OtherNORTH CAROLINA BOARD OF DIETETICS/NUTRITION