Provider Demographics
NPI:1518202795
Name:CLARK, JENNIFER JARRETT (MS, RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JARRETT
Last Name:CLARK
Suffix:
Gender:F
Credentials:MS, 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 52948
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37950-2948
Mailing Address - Country:US
Mailing Address - Phone:865-306-5708
Mailing Address - Fax:865-584-7712
Practice Address - Street 1:1819 W CLINCH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2434
Practice Address - Country:US
Practice Address - Phone:865-984-3413
Practice Address - Fax:865-212-5597
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDN0000002191133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered