Jessica Broyles, RD, LDN
Individual provider Active NPI Registered Dietitian · New Tazewell, TN
NPI 1366680423 · NPPES record last updated May 15, 2018
Key facts
- NPI
- 1366680423
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- 2071 (TN)
- Practice address
- 620 Davis Dr
New Tazewell, TN 37825 - Phone
- (423) 626-4291
- NPI assigned
- Jan 28, 2009
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2071 | TN | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| State of Tennessee | Past | Accepting new patients | |
| State of Tennessee | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 2071 | TN | Yes |
Addresses
Primary practice location
620 Davis Dr
New Tazewell, TN 37825
Mailing address
620 Davis Dr
New Tazewell, TN 37825-2152
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2071 | Other | TN | REGISTERED DIETITIAN LICENSE NUMBER |
Other providers in New Tazewell, TN
- Sheryl Ann Bishop
- Amber Blevins
- Quinn F Bowring
- William Herbert Brooks
- Juanita M Brown
- Mary Lou Cameron
- Kelsey Paige Carroll
- Cherokee Health Systems
- Claiborne Care Center
- Joseph J Collins
All providers in New Tazewell, TN · Registered Dietitian in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 15, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.