Healthcare Provider Details

I. General information

NPI: 1588192199
Provider Name (Legal Business Name): JESSICA-LAUREN ROBERTS NEWBY RDN, LD, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2017
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2692 W OXFORD LOOP STE 101
OXFORD MS
38655-5569
US

IV. Provider business mailing address

2692 W OXFORD LOOP STE 101
OXFORD MS
38655-5569
US

V. Phone/Fax

Practice location:
  • Phone: 334-245-1855
  • Fax: 844-409-2355
Mailing address:
  • Phone: 334-245-1855
  • Fax: 844-409-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number1924
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2020
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: