Provider Demographics
NPI:1972177509
Name:CHISARI, JESSICA (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:CHISARI
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:CHISARI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED DIETITIAN
Mailing Address - Street 1:4913 W RENO AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73127-6339
Mailing Address - Country:US
Mailing Address - Phone:405-948-4900
Mailing Address - Fax:405-948-4933
Practice Address - Street 1:4913 W RENO AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73127-6339
Practice Address - Country:US
Practice Address - Phone:405-948-4900
Practice Address - Fax:405-948-4933
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered