Provider Demographics
NPI:1205271079
Name:MCCARROLL, JESSI-LYNN MARIE (RD)
Entity type:Individual
Prefix:MISS
First Name:JESSI-LYNN
Middle Name:MARIE
Last Name:MCCARROLL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12300 SHERMAN WAY
Mailing Address - Street 2:C28
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-5527
Mailing Address - Country:US
Mailing Address - Phone:269-718-7070
Mailing Address - Fax:
Practice Address - Street 1:12300 SHERMAN WAY
Practice Address - Street 2:C28
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-5527
Practice Address - Country:US
Practice Address - Phone:269-718-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1087973133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered