=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144188616
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA JORGENSON RD, LD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2026
-----------------------------------------------------
Last Update Date | 01/22/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2375 E CAMELBACK RD STE 600
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85016-3493
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-341-5248
-----------------------------------------------------
Fax | 855-838-4958
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2375 E CAMELBACK RD STE 600
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85016-3493
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-341-5248
-----------------------------------------------------
Fax | 855-838-4958
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | DT88924
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------