Provider Demographics
NPI:1407279243
Name:GOFF, JESSICA (MS,RD,LDN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GOFF
Suffix:
Gender:F
Credentials:MS,RD,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 HEALTH PARK
Mailing Address - Street 2:STE 325
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-4730
Mailing Address - Country:US
Mailing Address - Phone:919-870-1001
Mailing Address - Fax:
Practice Address - Street 1:8300 HEALTH PARK
Practice Address - Street 2:STE 325
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-4730
Practice Address - Country:US
Practice Address - Phone:919-870-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-30
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004057133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered