Provider Demographics
NPI:1093382723
Name:STEBBINS, JESSICA L (RDN, LD)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:L
Last Name:STEBBINS
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 COMMONWEALTH BLVD
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-9301
Mailing Address - Country:US
Mailing Address - Phone:662-840-6366
Mailing Address - Fax:
Practice Address - Street 1:1114 COMMONWEALTH BLVD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-9301
Practice Address - Country:US
Practice Address - Phone:662-840-6366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD1796133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered