Provider Demographics
NPI:1275071938
Name:ALLEN, JODY LYNN (RDN, LD, CLEC)
Entity Type:Individual
Prefix:MRS
First Name:JODY
Middle Name:LYNN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:RDN, LD, CLEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 ELBURZ UNIT 6
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-7403
Mailing Address - Country:US
Mailing Address - Phone:757-218-9266
Mailing Address - Fax:
Practice Address - Street 1:802 ELBURZ RD UNIT 6
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-7403
Practice Address - Country:US
Practice Address - Phone:757-218-9266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV39140-DI-0133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered