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General NPI Number Information
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NPI Number | 1689517112
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Entity Type | Organization
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Legal Business Name | CUSTOM NUTRITION COACHING CO
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Dates
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Enumeration Date | 04/10/2026
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Last Update Date | 04/10/2026
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Provider Practice Location Address
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Address Line | 56 E REDFORD CT
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City | SAINT CHARLES
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State | MO
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Zip | 63304-5048
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Country | US
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Telephone | 618-541-1981
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Fax |
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Provider Business Mailing Address
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Address Line | 56 E REDFORD CT
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City | SAINT CHARLES
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State | MO
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Zip | 63304-5048
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Country | US
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Telephone | 618-541-1981
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Fax |
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Authorized Official
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Title or Position | OWNER, RDN
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Name | JESSICA NICOLE HUMPHRIES
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Credential | MS, RDN, LDN, CDCES
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Telephone | 618-541-1981
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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 |
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License Number State |
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