Provider Demographics
NPI:1477286847
Name:THURSTENSON, JACQUELINE HOPE (MS, RDN, LDN)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:HOPE
Last Name:THURSTENSON
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:MS
Other - First Name:JACQUELINE
Other - Middle Name:HOPE
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:843 E NORTHFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-1246
Mailing Address - Country:US
Mailing Address - Phone:615-861-9146
Mailing Address - Fax:
Practice Address - Street 1:843 E NORTHFIELD BLVD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-1246
Practice Address - Country:US
Practice Address - Phone:615-861-9146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4219133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered