MEDICARE: MS. JENNIFER LEA MEYERS MS, 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	511	AR

General Provider Information

NPI Number	:	1578178000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER LEA MEYERS MS, RD, LD

Provider Business Mailing Address
First Line	:	133 NANTUCKET LOOP
Second Line	:
City	:	MAUMELLE
State	:	AR
Zip	:	72113-7267
Country	:	US
Telephone Number	:	501-350-8316
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 BRIDGEWAY RD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72113-9516
Country	:	US
Telephone Number	:	501-350-8316
Fax Number	:

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

Provider Enumeration Date	:	09/11/2020
Last Update Date	:	09/11/2020

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