Provider Demographics
NPI:1437303963
Name:GILBREATH, JENNIFER ZELL (MS, RD, CSP,LD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ZELL
Last Name:GILBREATH
Suffix:
Gender:F
Credentials:MS, 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 1:1340 EMPIRE CENTRAL DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4022
Mailing Address - Country:US
Mailing Address - Phone:469-859-3099
Mailing Address - Fax:
Practice Address - Street 1:1340 EMPIRE CENTRAL DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4022
Practice Address - Country:US
Practice Address - Phone:469-859-3099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07625133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric