Provider Demographics
NPI:1013426907
Name:FRYER, JACQUELIN DANIELLE (RD, CSSD, CSCS)
Entity Type:Individual
Prefix:
First Name:JACQUELIN
Middle Name:DANIELLE
Last Name:FRYER
Suffix:
Gender:F
Credentials:RD, CSSD, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 BAY POINT DR
Mailing Address - Street 2:
Mailing Address - City:RAINBOW CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35906-7375
Mailing Address - Country:US
Mailing Address - Phone:908-894-8700
Mailing Address - Fax:
Practice Address - Street 1:1513 RAINBOW DR
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5370
Practice Address - Country:US
Practice Address - Phone:908-894-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-24
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2740133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered