Provider Demographics
NPI:1346764164
Name:BYERS, JESSICA (RDN, CDCES)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BYERS
Suffix:
Gender:F
Credentials:RDN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 WRIGHT ST APT 306
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1443
Mailing Address - Country:US
Mailing Address - Phone:815-291-3416
Mailing Address - Fax:
Practice Address - Street 1:11750 W 2ND PL STE 365
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1731
Practice Address - Country:US
Practice Address - Phone:720-321-8460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164007159133V00000X
CO86044158133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered