Provider Demographics
NPI:1053975987
Name:ANDERSON, JESSICA GRACE (MS,RD,CSSD,LD,EPC)
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:GRACE
Last Name:ANDERSON
Suffix:
Gender:
Credentials:MS,RD,CSSD,LD,EPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WOMACK ARMY MEDICAL CENTER 2817 ROCK MERRITT AVE
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-0001
Mailing Address - Country:US
Mailing Address - Phone:910-907-8116
Mailing Address - Fax:
Practice Address - Street 1:2817 ROCK MERRITT AVE
Practice Address - Street 2:WOMACK ARMY MEDICAL CENTER
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-5438
Practice Address - Country:US
Practice Address - Phone:910-907-8116
Practice Address - Fax:910-907-6069
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08619133N00000X
OHLD.08619133V00000X
NCL007668133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered