Provider Demographics
NPI:1669488581
Name:OKEMAH, JENNIFER T (MS, RD, CD, BC-ADM)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:T
Last Name:OKEMAH
Suffix:
Gender:F
Credentials:MS, RD, CD, BC-ADM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9727 NE JUANITA DR APT 205
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-4259
Mailing Address - Country:US
Mailing Address - Phone:425-299-8774
Mailing Address - Fax:
Practice Address - Street 1:11335 NE 122ND WAY STE 105205
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034
Practice Address - Country:US
Practice Address - Phone:425-285-5877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001847133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8457848Medicaid
WADI00001847OtherLICENSE
WADI00001847OtherLICENSE