Provider Demographics
NPI:1134624158
Name:HUGHES, JODI ELIZABETH (RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:ELIZABETH
Last Name:HUGHES
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 CAMDEN RD APT 358
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-6558
Mailing Address - Country:US
Mailing Address - Phone:847-224-0383
Mailing Address - Fax:
Practice Address - Street 1:640 SUMMIT CROSSING PL STE 205
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2183
Practice Address - Country:US
Practice Address - Phone:704-671-7838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005107133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty