Healthcare Provider Details

I. General information

NPI: 1235665266
Provider Name (Legal Business Name): JESSICA IVEY RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7191 CAHABA VALLEY RD
BIRMINGHAM AL
35242-6443
US

IV. Provider business mailing address

7191 CAHABA VALLEY RD
BIRMINGHAM AL
35242-6443
US

V. Phone/Fax

Practice location:
  • Phone: 205-408-6425
  • Fax: 205-408-6591
Mailing address:
  • Phone: 205-408-6425
  • Fax: 205-408-6591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number2533
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: