Provider Demographics
NPI:1215546569
Name:SHUPE, JESSICA (RD/RDN)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:SHUPE
Suffix:
Gender:F
Credentials:RD/RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 CUPID ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-5107
Mailing Address - Country:US
Mailing Address - Phone:504-606-9816
Mailing Address - Fax:
Practice Address - Street 1:91 WESTBANK EXPY STE 405
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-3677
Practice Address - Country:US
Practice Address - Phone:504-363-4899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered