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NPI Code Detail

MEDICARE: JESSICA NICOLE HUMPHRIES RD

MEDICARE: JESSICA NICOLE HUMPHRIES RD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian2019040081MO

General Provider Information

NPI Number : 1356012348
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA NICOLE HUMPHRIES RD
Provider Business Mailing Address
First Line : PO BOX 23340
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63156-3340
Country : US
Telephone Number : 314-851-1000
Fax Number :
Provider Business Practice Location Address
First Line : 1721 HERITAGE HILLS DR
Second Line :
City : WASHINGTON
State : MO
Zip : 63090-4621
Country : US
Telephone Number : 314-851-1000
Fax Number : 314-851-4445
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2021
Last Update Date : 10/04/2022

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Directions to “ JESSICA NICOLE HUMPHRIES RD” Practice Location

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