Individual
JACK KESSEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9525 N MERIDIAN ST, INDIANAPOLIS, IN 46260-1310
(317) 210-3244
Mailing address
9525 N MERIDIAN ST, INDIANAPOLIS, IN 46260-1310
(317) 210-3244
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
37003210A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86104699
COMMISSION ON DIETETIC COMMISSION
IN
Enumeration date
11/27/2024
Last updated
11/27/2024
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