Provider Demographics
NPI:1639334691
Name:RALEIGH, JACQUELYN DIANE (RD,LD,CDE)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:DIANE
Last Name:RALEIGH
Suffix:
Gender:F
Credentials:RD,LD,CDE
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:HUNTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13729 RESEARCH BLVD
Mailing Address - Street 2:STE 610-193
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1883
Mailing Address - Country:US
Mailing Address - Phone:512-250-9140
Mailing Address - Fax:512-250-2207
Practice Address - Street 1:6500 N MOPAC
Practice Address - Street 2:BLDG III, STE 220
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731
Practice Address - Country:US
Practice Address - Phone:512-250-9140
Practice Address - Fax:512-250-2207
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT80736133NN1002X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education