Provider Demographics
NPI:1760092084
Name:WALDEN, JESSICA C (MS, RD, LD, BBA)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:C
Last Name:WALDEN
Suffix:
Gender:F
Credentials:MS, RD, LD, BBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 NASHMONT DR
Mailing Address - Street 2:
Mailing Address - City:ONA
Mailing Address - State:WV
Mailing Address - Zip Code:25545-9541
Mailing Address - Country:US
Mailing Address - Phone:304-634-0325
Mailing Address - Fax:
Practice Address - Street 1:1022 NASHMONT DR
Practice Address - Street 2:
Practice Address - City:ONA
Practice Address - State:WV
Practice Address - Zip Code:25545-9541
Practice Address - Country:US
Practice Address - Phone:304-634-0325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-02
Last Update Date:2020-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV86029668133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered