Provider Demographics
NPI:1588943005
Name:NEWMAN, JESSIE L (RD)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:L
Last Name:NEWMAN
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:PO BOX 928
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78294-0928
Mailing Address - Country:US
Mailing Address - Phone:361-985-9500
Mailing Address - Fax:361-985-8906
Practice Address - Street 1:7121 S PADRE ISLAND DR
Practice Address - Street 2:SUITE 310
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4938
Practice Address - Country:US
Practice Address - Phone:361-985-9500
Practice Address - Fax:361-985-8906
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007030961133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered