Provider Demographics
NPI:1003617564
Name:VANDIVER, JENNA MARIE (RD)
Entity type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:MARIE
Last Name:VANDIVER
Suffix:
Gender:
Credentials:RD
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:MARIE
Other - Last Name:THALKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:520 WOODHILL CT
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-4400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:520 WOODHILL CT
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-4400
Practice Address - Country:US
Practice Address - Phone:616-830-8190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered