Provider Demographics
NPI:1952067621
Name:COLON, JESSICA L (RDN, LDN)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:L
Last Name:COLON
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 ELM HILL PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3108
Mailing Address - Country:US
Mailing Address - Phone:615-425-4200
Mailing Address - Fax:
Practice Address - Street 1:555 RACE ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-2347
Practice Address - Country:US
Practice Address - Phone:855-699-6937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND12076133V00000X
86107865133V00000X
OHLD.10040133V00000X
MN4942133V00000X
MO2022006384133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2022006384OtherMISSOURI DIVISION OF PROFESSIONAL REGISTRATION
AL3391OtherALABAMA BOARD OF DIETETICS AND NUTRITIONIST
IA115071OtherSTATE OF IOWA BOARD OF DIETETICS
86107865OtherCOMMISSION ON DIETETIC REGISTRATION
IL164.008463OtherILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION