Provider Demographics
NPI:1578178000
Name:MEYERS, JENNIFER LEA (MS, RD, LD)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LEA
Last Name:MEYERS
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MEYERS
Other - Last Name:MCDANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,RD,LD
Mailing Address - Street 1:133 NANTUCKET LOOP
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-7267
Mailing Address - Country:US
Mailing Address - Phone:501-350-8316
Mailing Address - Fax:
Practice Address - Street 1:21 BRIDGEWAY RD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72113-9516
Practice Address - Country:US
Practice Address - Phone:501-350-8316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR511133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered