Provider Demographics
NPI:1992581276
Name:MUELLER, JESSICA ANN (MS, RD, LMNT, LD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:MUELLER
Suffix:
Gender:F
Credentials:MS, RD, LMNT, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 PALACE DR STE C
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-6265
Mailing Address - Country:US
Mailing Address - Phone:402-926-8135
Mailing Address - Fax:
Practice Address - Street 1:1800 PALACE DR STE C
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-6265
Practice Address - Country:US
Practice Address - Phone:402-926-8135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1479133V00000X
KS2527133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered