Provider Demographics
NPI:1841226032
Name:JAMES, JENNIFER (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:JAMES
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 AUGUSTA DR
Mailing Address - Street 2:
Mailing Address - City:SANTA TERESA
Mailing Address - State:NM
Mailing Address - Zip Code:88008-9612
Mailing Address - Country:US
Mailing Address - Phone:915-544-3000
Mailing Address - Fax:915-544-3003
Practice Address - Street 1:4120 RIO BRAVO ST
Practice Address - Street 2:STE. 113
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-1052
Practice Address - Country:US
Practice Address - Phone:915-544-3000
Practice Address - Fax:915-544-3003
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT05017133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00565PMedicare ID - Type UnspecifiedLICENSED DIETITIAN