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General NPI Number Information
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NPI Number | 1871305821
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Entity Type | Individual
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Provider Name | JESSICA WILSON RD
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Gender | Female
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Dates
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Enumeration Date | 01/24/2025
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 3724 JEFFERSON ST STE 10
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City | AUSTIN
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State | TX
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Zip | 78731-6225
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Country | US
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Telephone | 512-399-9039
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Fax |
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Provider Business Mailing Address
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Address Line | 63 SHERMAN PL APT E2
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City | JERSEY CITY
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State | NJ
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Zip | 07307-3760
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Country | US
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Telephone | 732-547-0998
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Fax |
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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 | 86169444
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License Number State |
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