Provider Demographics
NPI:1114241338
Name:JENNINGS, LINDA STORY (MS, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:STORY
Last Name:JENNINGS
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 1:53 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:TALLASSEE
Mailing Address - State:AL
Mailing Address - Zip Code:36078-5828
Mailing Address - Country:US
Mailing Address - Phone:334-283-4442
Mailing Address - Fax:
Practice Address - Street 1:53 CLAY ST
Practice Address - Street 2:
Practice Address - City:TALLASSEE
Practice Address - State:AL
Practice Address - Zip Code:36078-5828
Practice Address - Country:US
Practice Address - Phone:334-283-4442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL265133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered