Provider Demographics
NPI:1891332904
Name:JESSICA BYRD WHITE LLC
Entity Type:Organization
Organization Name:JESSICA BYRD WHITE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:BYRD
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:334-791-0314
Mailing Address - Street 1:407 FORSYTHIA LN
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-5904
Mailing Address - Country:US
Mailing Address - Phone:334-791-0314
Mailing Address - Fax:
Practice Address - Street 1:3113 WESLEY WAY STE 2
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-2004
Practice Address - Country:US
Practice Address - Phone:334-245-8810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-08
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty