Provider Demographics
NPI:1831926476
Name:DAVIDSON, JESSICA (MPH, RD, LDN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:MPH, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4530 HARGROVE RD APT 201
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-2868
Mailing Address - Country:US
Mailing Address - Phone:910-641-2665
Mailing Address - Fax:
Practice Address - Street 1:1520 SUNDAY DR STE 309
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-5254
Practice Address - Country:US
Practice Address - Phone:919-354-7077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered