Provider Demographics
NPI:1598581316
Name:COPE, JESSICA NICOLE GARRISON (MS, RD, LD, CDCES)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICOLE GARRISON
Last Name:COPE
Suffix:
Gender:F
Credentials:MS, RD, LD, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 DALE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-4015
Mailing Address - Country:US
Mailing Address - Phone:816-716-6694
Mailing Address - Fax:
Practice Address - Street 1:111 SAINT LUKES CENTER DR STE 42B
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3509
Practice Address - Country:US
Practice Address - Phone:314-205-6483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016024170133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered