Provider Demographics
NPI:1124437421
Name:MYERS, JENNIFER (MS,RD,LD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MYERS
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 1:2600 TECHNOLOGY DR.
Mailing Address - Street 2:SUITE100
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074
Mailing Address - Country:US
Mailing Address - Phone:469-241-2500
Mailing Address - Fax:469-241-2599
Practice Address - Street 1:2600 TECHNOLOGY DR
Practice Address - Street 2:SUITE100
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-3732
Practice Address - Country:US
Practice Address - Phone:469-241-2500
Practice Address - Fax:469-241-2599
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81101133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered