=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730596180
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER JANE COTTON RD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2014
-----------------------------------------------------
Last Update Date | 08/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10718 POTRANCO RD
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78251-3312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-481-1149
-----------------------------------------------------
Fax | 855-710-7869
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 646 S FLORES ST
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78204-1219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-481-1149
-----------------------------------------------------
Fax | 855-710-7869
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | DT83300
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------