Provider Demographics
NPI:1952110975
Name:GOULD, JESSICA MARIE (RD)
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:MARIE
Last Name:GOULD
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 1:2887 STATE HIGHWAY V
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:MO
Mailing Address - Zip Code:65746-8047
Mailing Address - Country:US
Mailing Address - Phone:417-241-1462
Mailing Address - Fax:
Practice Address - Street 1:2887 STATE HIGHWAY V
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:MO
Practice Address - Zip Code:65746-8047
Practice Address - Country:US
Practice Address - Phone:417-241-1462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024043883133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered