Provider Demographics
NPI:1407152796
Name:COFFIE, JESSICA R (MS, CN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:COFFIE
Suffix:
Gender:F
Credentials:MS, CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 NEWTOWN CIR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-1240
Mailing Address - Country:US
Mailing Address - Phone:859-288-2333
Mailing Address - Fax:859-288-2328
Practice Address - Street 1:805 NEWTOWN CIR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-1240
Practice Address - Country:US
Practice Address - Phone:859-288-2333
Practice Address - Fax:859-288-2328
Is Sole Proprietor?:No
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2329133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist