Provider Demographics
NPI:1124603790
Name:HESTER, AUDREY NICOLE (RD, LD)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:NICOLE
Last Name:HESTER
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:NICOLE
Other - Last Name:REEVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1135 KALMIA ST
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97448-1951
Mailing Address - Country:US
Mailing Address - Phone:541-678-1626
Mailing Address - Fax:
Practice Address - Street 1:2200 NE PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6063
Practice Address - Country:US
Practice Address - Phone:541-389-6313
Practice Address - Fax:541-389-8760
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLD-D-10204853133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered