Provider Demographics
NPI:1962891085
Name:GOLD, JESSICA MICHELLE (NTP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MICHELLE
Last Name:GOLD
Suffix:
Gender:F
Credentials:NTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 JONES AVE
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-2908
Mailing Address - Country:US
Mailing Address - Phone:678-200-5953
Mailing Address - Fax:304-465-4325
Practice Address - Street 1:325 JONES AVE
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-2908
Practice Address - Country:US
Practice Address - Phone:678-200-5953
Practice Address - Fax:304-465-4325
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist