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General NPI Number Information
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NPI Number | 1235019639
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Entity Type | Individual
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Provider Name | JESSICA L FORNEY RD
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Gender | Female
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Dates
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Enumeration Date | 09/05/2025
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 110 HOSPITAL RD STE 101
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City | PRINCE FREDERICK
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State | MD
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Zip | 20678-4019
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Country | US
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Telephone | 410-535-8195
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Fax | 410-280-7323
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Provider Business Mailing Address
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Address Line | 100 HOSPITAL RD
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City | PRINCE FREDERICK
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State | MD
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Zip | 20678-4017
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Country | US
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Telephone | 410-414-4791
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Fax | 410-535-8417
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | DX4260
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License Number State | MD
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