Provider Demographics
NPI:1962873562
Name:KORONI, JESSICA (MS, RD, LD, CEDS)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:KORONI
Suffix:
Gender:F
Credentials:MS, RD, LD, CEDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 W TREMONT AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-4902
Mailing Address - Country:US
Mailing Address - Phone:704-266-0864
Mailing Address - Fax:919-386-4604
Practice Address - Street 1:307 W TREMONT AVE STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4902
Practice Address - Country:US
Practice Address - Phone:704-266-0864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-08
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86050678133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered