Provider Demographics
NPI:1821232059
Name:WARD, JESSICA L (RD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:WARD
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 1:8190 W NIXON RD
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47396-9646
Mailing Address - Country:US
Mailing Address - Phone:765-212-4990
Mailing Address - Fax:
Practice Address - Street 1:8190 W NIXON RD
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:IN
Practice Address - Zip Code:47396-9646
Practice Address - Country:US
Practice Address - Phone:765-212-4990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37001289A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered