Individual
JESSICA MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
4199 GATEWAY BLVD, NEWBURGH, IN 47630-8940
(812) 858-5938
Mailing address
4199 GATEWAY BLVD, NEWBURGH, IN 47630-8940
(812) 858-5938
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
37001949A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37001949A
STATE LICENSE
IN
Enumeration date
08/22/2019
Last updated
08/22/2019
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