Provider Demographics
NPI:1174345789
Name:CRAIGMILE, JESSICA MARIE (RD, LD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:CRAIGMILE
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 1:1533 48TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50311-2456
Mailing Address - Country:US
Mailing Address - Phone:515-201-8813
Mailing Address - Fax:
Practice Address - Street 1:1533 48TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50311-2456
Practice Address - Country:US
Practice Address - Phone:515-201-8813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-26
Last Update Date:2024-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86299260133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered