Provider Demographics
NPI:1174676852
Name:DEHART, JENNIFER S (MS,RD,LD,CNSD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:DEHART
Suffix:
Gender:F
Credentials:MS,RD,LD,CNSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4845 LONGMEADOW LN
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-7011
Mailing Address - Country:US
Mailing Address - Phone:205-533-7677
Mailing Address - Fax:
Practice Address - Street 1:4845 LONGMEADOW LN
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-7011
Practice Address - Country:US
Practice Address - Phone:205-533-7677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL989133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic