Provider Demographics
NPI:1467728063
Name:MOFFETT, JENNIFER JANE (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JANE
Last Name:MOFFETT
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12303 DEPAUL DR.
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2588
Mailing Address - Country:US
Mailing Address - Phone:314-344-6000
Mailing Address - Fax:314-344-6936
Practice Address - Street 1:1380 BLUEFIELD DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-2102
Practice Address - Country:US
Practice Address - Phone:314-344-6000
Practice Address - Fax:314-344-6936
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001007655133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered