Provider Demographics
NPI:1013389949
Name:WRYE, JESSICA (RDN, CDCES)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:WRYE
Suffix:
Gender:F
Credentials:RDN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1443 MAIN ST STE 130B
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-1939
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:833-550-0326
Practice Address - Street 1:1443 MAIN ST STE 130B
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-1939
Practice Address - Country:US
Practice Address - Phone:707-200-1178
Practice Address - Fax:833-550-0326
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-30
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86014138133N00000X, 133V00000X
133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education