Provider Demographics
NPI:1003228875
Name:PERRY, JENNIFER (RD, LDN, CDE)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:RD, LDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 MORGANTON BLVD SW
Mailing Address - Street 2:QUEST4LIFE
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-5677
Mailing Address - Country:US
Mailing Address - Phone:828-757-6450
Mailing Address - Fax:828-757-6454
Practice Address - Street 1:1031 MORGANTON BLVD SW
Practice Address - Street 2:QUEST4LIFE
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5677
Practice Address - Country:US
Practice Address - Phone:828-757-6450
Practice Address - Fax:828-757-6454
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002602133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered