Provider Demographics
NPI:1447554464
Name:DENEKE, JESSICA (RD, LD, CDE)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:DENEKE
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1829 FIRESTONE CT
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-2597
Mailing Address - Country:US
Mailing Address - Phone:334-590-5904
Mailing Address - Fax:334-209-0613
Practice Address - Street 1:1829 FIRESTONE COURT
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830
Practice Address - Country:US
Practice Address - Phone:334-590-5904
Practice Address - Fax:334-209-0613
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1645133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered