Provider Demographics
NPI:1417374158
Name:PENCE, JESSICA A (RDN, LD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:PENCE
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5450 FRANTZ RD STE 360
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4141
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4882 E MAIN ST
Practice Address - Street 2:SUITE 210
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-3189
Practice Address - Country:US
Practice Address - Phone:614-566-0610
Practice Address - Fax:614-566-0611
Is Sole Proprietor?:No
Enumeration Date:2014-03-19
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7283133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered