Provider Demographics
NPI:1205825221
Name:ROGERS, JENNIFER LEIGH (RD)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LEIGH
Last Name:ROGERS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:LEIGH
Other - Last Name:EAGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:250 TREELINE PARK
Mailing Address - Street 2:APT 802
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1882
Mailing Address - Country:US
Mailing Address - Phone:210-916-2596
Mailing Address - Fax:210-916-1991
Practice Address - Street 1:3851 ROGER BROOKE DR
Practice Address - Street 2:MCHE-QD (CREDENTIALS)
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4501
Practice Address - Country:US
Practice Address - Phone:210-916-2460
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06586133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered