Provider Demographics
NPI:1316555717
Name:HORNIKEL, JACQUELINE (MS, RDN, LD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:HORNIKEL
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 OXMOOR PL
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211-6443
Mailing Address - Country:US
Mailing Address - Phone:973-270-3831
Mailing Address - Fax:
Practice Address - Street 1:256 OXMOOR PL
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-6443
Practice Address - Country:US
Practice Address - Phone:973-270-3831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered