Provider Demographics
NPI:1740842004
Name:HANES, JENNIFER N (RDN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:N
Last Name:HANES
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9173 BENEVOLENT CT
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:76227-1305
Mailing Address - Country:US
Mailing Address - Phone:214-621-0584
Mailing Address - Fax:
Practice Address - Street 1:9173 BENEVOLENT CT
Practice Address - Street 2:
Practice Address - City:PROVIDENCE VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:76227-1305
Practice Address - Country:US
Practice Address - Phone:214-621-0584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-07
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
TX133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered