Provider Demographics
NPI:1013553056
Name:JOPLIN, JACY ANN AMANDA (RD, LD)
Entity Type:Individual
Prefix:
First Name:JACY
Middle Name:ANN AMANDA
Last Name:JOPLIN
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 HUDNALL ST APT 9201
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-9217
Mailing Address - Country:US
Mailing Address - Phone:940-390-1894
Mailing Address - Fax:
Practice Address - Street 1:2633 DALLAS PKWY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4742
Practice Address - Country:US
Practice Address - Phone:940-390-1894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT86219133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered