MEDICARE: JENNIFER QUALLS RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1225425218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER QUALLS RD

Provider Business Mailing Address
First Line	:	1310 24TH AVE S
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37212-2637
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1310 24TH AVE S
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37212-2637
Country	:	US
Telephone Number	:	708-665-4512
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2015
Last Update Date	:	05/01/2026

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