Provider Demographics
NPI:1700063328
Name:CUPP, JESSICA L (RD)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:L
Last Name:CUPP
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:FORGIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:3184 CHURN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-2122
Mailing Address - Country:US
Mailing Address - Phone:530-226-1759
Mailing Address - Fax:
Practice Address - Street 1:3184 CHURN CREEK RD
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2122
Practice Address - Country:US
Practice Address - Phone:530-226-1759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered