MEDICARE: JENNIFER D WIMPEE RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	DT07705	TX

General Provider Information

NPI Number	:	1033420310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER D WIMPEE RD

Provider Business Mailing Address
First Line	:	13100 NORTHWEST FREEWAY
Second Line	:	SUITE 400
City	:	HOUSTON
State	:	TX
Zip	:	77040-6346
Country	:	US
Telephone Number	:	832-237-3500
Fax Number	:	281-897-9906

Provider Business Practice Location Address
First Line	:	7863 CALLAGHAN ROAD
Second Line	:	SUITE 206
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-2452
Country	:	US
Telephone Number	:	832-237-3500
Fax Number	:	281-897-9906

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2010
Last Update Date	:	04/06/2015

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