Provider Demographics
NPI:1700407095
Name:WOODFORD, JESSICA (RD)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:WOODFORD
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 1:7000 JENNER RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-8176
Mailing Address - Country:US
Mailing Address - Phone:812-480-2305
Mailing Address - Fax:
Practice Address - Street 1:7000 JENNER RD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8176
Practice Address - Country:US
Practice Address - Phone:812-480-2305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered