Provider Demographics
NPI:1033554571
Name:ADAMS, JENNIFER RENEE (MS, RD, LD)
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:RENEE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21303 ENCINO COMMONS
Mailing Address - Street 2:APT 1703
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-2696
Mailing Address - Country:US
Mailing Address - Phone:325-518-6627
Mailing Address - Fax:
Practice Address - Street 1:1020 S STATE HIGHWAY 16
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4471
Practice Address - Country:US
Practice Address - Phone:830-997-1312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT82237133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1076885OtherREGISTERED DIETITIAN
TXDT82237OtherLICENSED DIETITIAN