Provider Demographics
NPI:1487143244
Name:BURROUGHS, JASMINE (RD, LDN)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:BURROUGHS
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5015 MILLER DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-1877
Mailing Address - Country:US
Mailing Address - Phone:984-329-9225
Mailing Address - Fax:
Practice Address - Street 1:5015 MILLER DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-1877
Practice Address - Country:US
Practice Address - Phone:252-822-2834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC133V00000X
NCL005442133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered