Provider Demographics
NPI:1730671074
Name:GRAY, JENNIFER DOWNES (RDN, LD, CNSC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DOWNES
Last Name:GRAY
Suffix:
Gender:F
Credentials:RDN, LD, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 OLD DENTON RD APT 7210
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-2336
Mailing Address - Country:US
Mailing Address - Phone:918-630-8370
Mailing Address - Fax:
Practice Address - Street 1:3388 MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-4553
Practice Address - Country:US
Practice Address - Phone:918-630-8370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-02
Last Update Date:2018-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83211133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered