Provider Demographics
NPI:1841011889
Name:GORDON, JESSICA L (RD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:GORDON
Suffix:
Gender:
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6327 MERONA LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77041-6807
Mailing Address - Country:US
Mailing Address - Phone:210-385-0553
Mailing Address - Fax:
Practice Address - Street 1:8627 HUFSMITH RD APT 1533
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-2672
Practice Address - Country:US
Practice Address - Phone:210-385-0553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-22
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86299418133V00000X
TXDT89191133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered