Provider Demographics
NPI:1538813977
Name:FRALIN, JACOB CLAY (RD)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:CLAY
Last Name:FRALIN
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 N 31ST ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-6705
Mailing Address - Country:US
Mailing Address - Phone:804-385-6002
Mailing Address - Fax:
Practice Address - Street 1:1301 N 31ST ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-6705
Practice Address - Country:US
Practice Address - Phone:804-385-6002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA86101216133V00000X
MDDX7085133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty