Provider Demographics
NPI:1154195469
Name:GREEN, JESSICA ERIN (RDN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ERIN
Last Name:GREEN
Suffix:
Gender:
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11700 W. 2ND PLACE
Mailing Address - Street 2:MEDICAL PLAZA 2, STE 310
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228
Mailing Address - Country:US
Mailing Address - Phone:720-321-8300
Mailing Address - Fax:720-321-8301
Practice Address - Street 1:11700 W. 2ND PLACE
Practice Address - Street 2:MEDICAL PLAZA 2, STE 310
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228
Practice Address - Country:US
Practice Address - Phone:720-321-8300
Practice Address - Fax:720-321-8301
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-08
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLD-1352133V00000X
OR10202320133V00000X
WA61000856133V00000X
ID1154133V00000X
133V00000X
TXDT81445133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered