Provider Demographics
NPI:1518328665
Name:BISHOP, JENNA (RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:
Last Name:BISHOP
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 1:3127 W CHADWICK LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-1018
Mailing Address - Country:US
Mailing Address - Phone:309-713-6502
Mailing Address - Fax:
Practice Address - Street 1:355 NEW SHACKLE ISLAND RD STE 128B
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2479
Practice Address - Country:US
Practice Address - Phone:615-492-6116
Practice Address - Fax:615-334-8962
Is Sole Proprietor?:No
Enumeration Date:2016-03-17
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4791133V00000X
IL164005610133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL164005610OtherRD LICENSE