Provider Demographics
NPI:1477911840
Name:WEDDINGTON-NUNEZ, JESSICA RENEE (RD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENEE
Last Name:WEDDINGTON-NUNEZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 N WHISENANT DR
Mailing Address - Street 2:FOOD AND NUTRITION SERVICES
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1650
Mailing Address - Country:US
Mailing Address - Phone:580-251-8771
Mailing Address - Fax:
Practice Address - Street 1:1407 N WHISENANT DR
Practice Address - Street 2:FOOD AND NUTRITION SERVICES
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1650
Practice Address - Country:US
Practice Address - Phone:580-251-8771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1910133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered