Healthcare Provider Details

I. General information

NPI: 1548191422
Provider Name (Legal Business Name): JESSICA LYNN DURGAN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 N HELENA ST STE C
SPOKANE WA
99202-2826
US

IV. Provider business mailing address

711 N HELENA ST STE C
SPOKANE WA
99202-2826
US

V. Phone/Fax

Practice location:
  • Phone: 303-918-0569
  • Fax:
Mailing address:
  • Phone: 303-918-0569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDIET.DI.70108611
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: