Provider Demographics
NPI:1881272888
Name:EDGERLY, JACQUELINE (NTP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:EDGERLY
Suffix:
Gender:F
Credentials:NTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 ESCALANTE RD
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:CO
Mailing Address - Zip Code:81623-9720
Mailing Address - Country:US
Mailing Address - Phone:970-379-3221
Mailing Address - Fax:
Practice Address - Street 1:131 ESCALANTE RD
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:CO
Practice Address - Zip Code:81623-9720
Practice Address - Country:US
Practice Address - Phone:970-379-3221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education