Provider Demographics
NPI:1750700795
Name:SPRUILL, JESSICA BROWN (RDN, LDN)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:BROWN
Last Name:SPRUILL
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 246 801 NORTH KING ST
Mailing Address - Street 2:
Mailing Address - City:WINTON
Mailing Address - State:NC
Mailing Address - Zip Code:27986
Mailing Address - Country:US
Mailing Address - Phone:252-358-7833
Mailing Address - Fax:252-358-7869
Practice Address - Street 1:718 EVANS STREET
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910
Practice Address - Country:US
Practice Address - Phone:252-862-4217
Practice Address - Fax:252-332-4494
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004262133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered