Provider Demographics
NPI:1205941507
Name:EARNEST, JENNIFER LEE (RD, LDN)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LEE
Last Name:EARNEST
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1064
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35594-1064
Mailing Address - Country:US
Mailing Address - Phone:901-624-5414
Mailing Address - Fax:
Practice Address - Street 1:1030 JEFFERSON AVE
Practice Address - Street 2:NUTRITION AND FOOD SERVICES (120)
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2127
Practice Address - Country:US
Practice Address - Phone:901-523-8990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001704132700000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered132700000XDietary & Nutritional Service ProvidersDietary Manager
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered