Provider Demographics
NPI:1851281117
Name:COLLETTE, JESSICA (RDN,LDN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:COLLETTE
Suffix:
Gender:F
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 1:13108 WILLOW TREE CT
Mailing Address - Street 2:
Mailing Address - City:HASLET
Mailing Address - State:TX
Mailing Address - Zip Code:76052-6232
Mailing Address - Country:US
Mailing Address - Phone:580-919-3008
Mailing Address - Fax:
Practice Address - Street 1:13108 WILLOW TREE CT
Practice Address - Street 2:
Practice Address - City:HASLET
Practice Address - State:TX
Practice Address - Zip Code:76052-6232
Practice Address - Country:US
Practice Address - Phone:580-919-3008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5635133V00000X
TN5046133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered