Healthcare Provider Details

I. General information

NPI: 1558559559
Provider Name (Legal Business Name): JENNIFER JONES MASTERS M.S., R.D.N, L.D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4874 HARVEST MILL WAY
KNOXVILLE TN
37918-1747
US

IV. Provider business mailing address

6234 PATEL WAY
KNOXVILLE TN
37909-4700
US

V. Phone/Fax

Practice location:
  • Phone: 865-322-3663
  • Fax: 865-444-2175
Mailing address:
  • Phone: 865-322-3663
  • Fax: 865-444-2175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberLDN0000000416
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberLDN0000000416
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLDN0000000416
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: