Provider Demographics
NPI:1265156665
Name:SHIPMAN, JAELYN MURPHY (RD)
Entity type:Individual
Prefix:MRS
First Name:JAELYN
Middle Name:MURPHY
Last Name:SHIPMAN
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 1:482 HUNTON FOREST DR NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-0084
Mailing Address - Country:US
Mailing Address - Phone:704-661-7191
Mailing Address - Fax:
Practice Address - Street 1:482 HUNTON FOREST DR NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-0084
Practice Address - Country:US
Practice Address - Phone:704-661-7191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004983133VN1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics