Provider Demographics
NPI:1386098135
Name:BEARDSLEY, JESSICA (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BEARDSLEY
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 WOOD CIR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2421
Mailing Address - Country:US
Mailing Address - Phone:404-213-0823
Mailing Address - Fax:
Practice Address - Street 1:209 WOOD CIR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2421
Practice Address - Country:US
Practice Address - Phone:404-213-0823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004497133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered