Provider Demographics
NPI:1073827994
Name:COFFEE, JESSICA JULSTEDT (RD, LD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JULSTEDT
Last Name:COFFEE
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 TIMBER CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-9225
Mailing Address - Country:US
Mailing Address - Phone:817-366-4643
Mailing Address - Fax:
Practice Address - Street 1:1209 TIMBER CT
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-9225
Practice Address - Country:US
Practice Address - Phone:817-366-4643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81448133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered