Provider Demographics
NPI:1689130932
Name:CLEMENTS, JENIFER HOWELL (RDN)
Entity Type:Individual
Prefix:
First Name:JENIFER
Middle Name:HOWELL
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 MONTEVALLO RD STE D108
Mailing Address - Street 2:
Mailing Address - City:IRONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35210-3128
Mailing Address - Country:US
Mailing Address - Phone:205-710-4445
Mailing Address - Fax:
Practice Address - Street 1:928 GILLESPIE ST
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-5414
Practice Address - Country:US
Practice Address - Phone:334-595-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2049133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered