Provider Demographics
NPI:1639216062
Name:COFFEY, JESSIE A (RD)
Entity Type:Individual
Prefix:MS
First Name:JESSIE
Middle Name:A
Last Name:COFFEY
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 1:5211 W CHADDERTON CIR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-4323
Mailing Address - Country:US
Mailing Address - Phone:402-436-1745
Mailing Address - Fax:
Practice Address - Street 1:5211 W CHADDERTON CIR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-4323
Practice Address - Country:US
Practice Address - Phone:402-436-1745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE816133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered