Provider Demographics
NPI:1588192199
Name:NEWBY, JESSICA-LAUREN ROBERTS (RDN, LD, IBCLC)
Entity Type:Individual
Prefix:
First Name:JESSICA-LAUREN
Middle Name:ROBERTS
Last Name:NEWBY
Suffix:
Gender:F
Credentials:RDN, LD, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2692 W OXFORD LOOP STE 101
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5569
Mailing Address - Country:US
Mailing Address - Phone:334-245-1855
Mailing Address - Fax:844-409-2355
Practice Address - Street 1:2692 W OXFORD LOOP STE 101
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5569
Practice Address - Country:US
Practice Address - Phone:334-245-1855
Practice Address - Fax:844-409-2355
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-25
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1924133VN1004X
AL2020133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, PediatricGroup - Multi-Specialty