Provider Demographics
NPI:1508218975
Name:SIMMONS, JENNIFER P (PHD,RD,LF)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:P
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:PHD,RD,LF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 FANNIN ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-3842
Mailing Address - Country:US
Mailing Address - Phone:409-833-6900
Mailing Address - Fax:409-833-6908
Practice Address - Street 1:3440 FANNIN ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-3842
Practice Address - Country:US
Practice Address - Phone:409-833-6900
Practice Address - Fax:409-833-6908
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-08
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT82164133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered