Healthcare Provider Details

I. General information

NPI: 1154978617
Provider Name (Legal Business Name): JENNIFER THOMPSON MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 09/09/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 WHATLEY DRIVE SUITE 2
DOTHAN AL
36303-1986
US

IV. Provider business mailing address

1600 WHATLEY DRIVE SUITE 2
DOTHAN AL
36303
US

V. Phone/Fax

Practice location:
  • Phone: 334-790-0734
  • Fax:
Mailing address:
  • Phone: 334-790-0734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1988
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: