Provider Demographics
NPI:1215716782
Name:WHITE, JARED JAMES (RD LD CNSC)
Entity type:Individual
Prefix:MR
First Name:JARED
Middle Name:JAMES
Last Name:WHITE
Suffix:
Gender:M
Credentials:RD LD CNSC
Other - Prefix:MR
Other - First Name:JARED
Other - Middle Name:JAMES
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:JARED J WHITE
Mailing Address - Street 1:1111 E CESAR CHAVEZ ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-4209
Mailing Address - Country:US
Mailing Address - Phone:512-978-8000
Mailing Address - Fax:
Practice Address - Street 1:5339 N IH 35
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-2557
Practice Address - Country:US
Practice Address - Phone:512-978-8130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT82516133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered