Provider Demographics
NPI:1801372131
Name:KREMPHOLTZ, JESSIE (MS, RDN, CDN)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:KREMPHOLTZ
Suffix:
Gender:F
Credentials:MS, RDN, CDN
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:
Other - Last Name:DALY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RDN, CDN
Mailing Address - Street 1:4522 HUNTERS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WALES CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:14169-9405
Mailing Address - Country:US
Mailing Address - Phone:716-982-9130
Mailing Address - Fax:
Practice Address - Street 1:2801 WEHRLE DR STE 4
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7381
Practice Address - Country:US
Practice Address - Phone:716-626-7415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-19
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X, 133V00000X
NY009425133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY009425OtherNYS CERTIFICATION