Individual
ROBERTA O'CONNOR JUPP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
147 VERA RD STE E, LEXINGTON, SC 29072-3756
(803) 399-0212
(803) 728-3224
Mailing address
723 ELLIPTIC GREEN LN, LEXINGTON, SC 29073-7057
(803) 622-9104
(803) 728-3224
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
131
SC
133V00000X
Registered Dietitian
726464
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DPE012
—
SC
Enumeration date
03/15/2007
Last updated
04/26/2023
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