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NPI Code Detail

MEDICARE: MS. JACQUELINE K ENLUND MPH RDN LD

MEDICARE: MS. JACQUELINE K ENLUND MPH RDN LD
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
1133V00000XRegistered Dietitian655SC

General Provider Information

NPI Number : 1962378984
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JACQUELINE K ENLUND MPH RDN LD
Provider Business Mailing Address
First Line : 758 SILVER BLUFF RD UNIT 5113
Second Line :
City : AIKEN
State : SC
Zip : 29803-4018
Country : US
Telephone Number : 803-270-7520
Fax Number :
Provider Business Practice Location Address
First Line : 758 SILVER BLUFF RD UNIT 5113
Second Line :
City : AIKEN
State : SC
Zip : 29803-4018
Country : US
Telephone Number : 803-270-7520
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/15/2025
Last Update Date : 10/20/2025

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