Provider Demographics
NPI:1073363859
Name:JACOBS, ELIZABETH O'MEARA (RDN, LD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:O'MEARA
Last Name:JACOBS
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 WILD PLUM DR
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-5283
Mailing Address - Country:US
Mailing Address - Phone:713-483-4678
Mailing Address - Fax:
Practice Address - Street 1:303 WILD PLUM DR
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-5283
Practice Address - Country:US
Practice Address - Phone:713-483-4678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT80884133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered