Provider Demographics
NPI:1629536560
Name:JEFFERSON, TRICIA LYNN (RD)
Entity Type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:LYNN
Last Name:JEFFERSON
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 1:2915 BODINE DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-2246
Mailing Address - Country:US
Mailing Address - Phone:302-420-0824
Mailing Address - Fax:302-250-4895
Practice Address - Street 1:2915 BODINE DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-2246
Practice Address - Country:US
Practice Address - Phone:302-420-0824
Practice Address - Fax:302-250-4895
Is Sole Proprietor?:No
Enumeration Date:2019-03-11
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEDN0000273133V00000X
174H00000X
TXDT89497133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174H00000XOther Service ProvidersHealth Educator