Provider Demographics
NPI:1851413934
Name:PORTER, JENNIE (RD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIE
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:RD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 MAKENNA ST
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245-4502
Mailing Address - Country:US
Mailing Address - Phone:559-924-0663
Mailing Address - Fax:559-924-7268
Practice Address - Street 1:970 MAKENNA ST
Practice Address - Street 2:
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93245-4502
Practice Address - Country:US
Practice Address - Phone:559-924-0663
Practice Address - Fax:559-924-7268
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
830844133NN1002X, 133V00000X, 133VN1005X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Not Answered133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Not Answered133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic