Provider Demographics
NPI:1023045044
Name:FELGATE, JENNIFER S (MS, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:S
Last Name:FELGATE
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1662 HIGDON FERRY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6912
Mailing Address - Country:US
Mailing Address - Phone:501-623-5445
Mailing Address - Fax:501-623-1774
Practice Address - Street 1:1662 HIGDON FERRY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6912
Practice Address - Country:US
Practice Address - Phone:501-623-5445
Practice Address - Fax:501-623-1774
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR943133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AROTH000Medicare UPIN
AR5A2817470Medicare PIN