Individual
JESSICA DIVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
1920 E CAMBRIDGE AVE STE 201, PHOENIX, AZ 85006-1462
(602) 933-0935
(602) 933-2471
Mailing address
2108 E THOMAS RD STE 130, PHOENIX, AZ 85016-0008
(602) 933-3124
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86094146
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86094146
COMMISON ON DIETETIC REGISTRATION
AZ
Enumeration date
03/31/2021
Last updated
03/03/2026
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