Healthcare Provider Details

I. General information

NPI: 1811710866
Provider Name (Legal Business Name): JENNIFER EBLEN GEBHARD MS, RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18942 HONEY MESQUITE
SAN ANTONIO TX
78258-1635
US

IV. Provider business mailing address

18942 HONEY MESQUITE
SAN ANTONIO TX
78258-1635
US

V. Phone/Fax

Practice location:
  • Phone: 512-791-8182
  • Fax:
Mailing address:
  • Phone: 512-791-8182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT82366
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: