Healthcare Provider Details

I. General information

NPI: 1326010414
Provider Name (Legal Business Name): JENNIFER JO KAPPEN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER JO HELMER RD

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 AIRPORT HEIGHTS DR STE 278
ANCHORAGE AK
99508-2965
US

IV. Provider business mailing address

4011 WORONZOF DR
ANCHORAGE AK
99517-1419
US

V. Phone/Fax

Practice location:
  • Phone: 907-929-4263
  • Fax:
Mailing address:
  • Phone: 575-513-5414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number156
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: