Provider Demographics
NPI:1689976227
Name:DYSON, JENNIFER LYNN (RD, LD, CDE)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:DYSON
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:ZIERVOGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17510 W GRAND PKWY S
Mailing Address - Street 2:SUITE 360
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2645
Mailing Address - Country:US
Mailing Address - Phone:281-239-3777
Mailing Address - Fax:281-239-3744
Practice Address - Street 1:17510 W GRAND PKWY S
Practice Address - Street 2:SUITE 360
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2645
Practice Address - Country:US
Practice Address - Phone:281-239-3777
Practice Address - Fax:281-239-3744
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81689133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX382504ZMLOtherMEDICARE PTAN