Healthcare Provider Details

I. General information

NPI: 1790851566
Provider Name (Legal Business Name): JENELLE WEST RDN, MDA, CD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2006
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1628 HEIDI PL
RICHLAND WA
99352-5704
US

IV. Provider business mailing address

1628 HEIDI PL
RICHLAND WA
99352-5704
US

V. Phone/Fax

Practice location:
  • Phone: 509-599-4500
  • Fax:
Mailing address:
  • Phone: 509-599-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI61219177
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: