Provider Demographics
NPI:1558559559
Name:MASTERS, JENNIFER JONES (MS, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JONES
Last Name:MASTERS
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6234 PATEL WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-4700
Mailing Address - Country:US
Mailing Address - Phone:865-322-3663
Mailing Address - Fax:865-444-2175
Practice Address - Street 1:4874 HARVEST MILL WAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-1747
Practice Address - Country:US
Practice Address - Phone:865-322-3663
Practice Address - Fax:865-444-2175
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDN0000000416133N00000X, 133VN1004X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric