Provider Demographics
NPI:1043087463
Name:METCALF, JACQUELYNN (RD, LD)
Entity Type:Individual
Prefix:
First Name:JACQUELYNN
Middle Name:
Last Name:METCALF
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 1:56 LANCEFORD CIR
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-8665
Mailing Address - Country:US
Mailing Address - Phone:850-712-4554
Mailing Address - Fax:
Practice Address - Street 1:56 LANCEFORD CIR
Practice Address - Street 2:
Practice Address - City:FLETCHER
Practice Address - State:NC
Practice Address - Zip Code:28732-8665
Practice Address - Country:US
Practice Address - Phone:850-712-4554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003954133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered