MEDICARE: JESSICA KORONI MS, RD, LD, CEDS

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
1	133V00000X	Registered Dietitian	86050678	TX

General Provider Information

NPI Number	:	1962873562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA KORONI MS, RD, LD, CEDS

Provider Business Mailing Address
First Line	:	307 W TREMONT AVE STE 200
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-4902
Country	:	US
Telephone Number	:	704-266-0864
Fax Number	:	919-386-4604

Provider Business Practice Location Address
First Line	:	307 W TREMONT AVE STE 200
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-4902
Country	:	US
Telephone Number	:	704-266-0864
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2015
Last Update Date	:	04/14/2022

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