MEDICARE: JENNIFER MCGOWAN MPH, RD, LD

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	5813	MN

General Provider Information

NPI Number	:	1265360085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MCGOWAN MPH, RD, LD

Provider Business Mailing Address
First Line	:	6848 ARTHUR HILLS DR
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23188-7258
Country	:	US
Telephone Number	:	770-366-5102
Fax Number	:

Provider Business Practice Location Address
First Line	:	619 8TH ST SE UNIT 406
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55414-1183
Country	:	US
Telephone Number	:	770-366-5102
Fax Number	:

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

Provider Enumeration Date	:	05/12/2026
Last Update Date	:	05/12/2026

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