Provider Demographics
NPI:1508756248
Name:ERLANDSON, JACQUELINE MARIA (RD)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:MARIA
Last Name:ERLANDSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:JACQUELINE
Other - Middle Name:MARIA
Other - Last Name:ERLANDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:632 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-3943
Mailing Address - Country:US
Mailing Address - Phone:903-520-6466
Mailing Address - Fax:
Practice Address - Street 1:632 W 8TH ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-3943
Practice Address - Country:US
Practice Address - Phone:903-533-1889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-04
Last Update Date:2025-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83973133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered