Provider Demographics
NPI:1184023616
Name:REEVES, JENNIFER (RD, CSP, LD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:REEVES
Suffix:
Gender:F
Credentials:RD, CSP, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8303 EDGEMOOR PL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-3704
Mailing Address - Country:US
Mailing Address - Phone:512-296-9034
Mailing Address - Fax:
Practice Address - Street 1:8303 EDGEMOOR PL
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-3704
Practice Address - Country:US
Practice Address - Phone:512-296-9034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07531133V00000X, 133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered