Provider Demographics
NPI:1093312167
Name:BRAND, JESSICA (MS, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BRAND
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7188 TUMBLEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-8891
Mailing Address - Country:US
Mailing Address - Phone:614-551-0012
Mailing Address - Fax:
Practice Address - Street 1:7188 TUMBLEBROOK DR
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-8891
Practice Address - Country:US
Practice Address - Phone:614-551-0012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.09234133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered