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General NPI Number Information
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NPI Number | 1851962625
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Entity Type | Organization
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Legal Business Name | JENNI K NUTRITION, LLC
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Dates
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Enumeration Date | 07/02/2021
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Last Update Date | 07/02/2021
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Provider Practice Location Address
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Address Line | 13017 BEAR DANCER TRL NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-3726
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Country | US
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Telephone | 505-596-0314
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Fax |
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Provider Business Mailing Address
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Address Line | 11024 MONTGOMERY BLVD NE # 260
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-3962
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Country | US
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Telephone | 505-596-0314
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Fax |
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Authorized Official
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Title or Position | REGISTERED DIETITIAN NUTRITIONIST
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Name | MS. JENNIFER K JACKSON
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Credential | MPH, RDN, LD
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Telephone | 505-596-0314
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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