Provider Demographics
NPI:1386094365
Name:LAWS, JACQUELYN
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:LAWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3770 NEW HOPE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:PALMERSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38241-5199
Mailing Address - Country:US
Mailing Address - Phone:731-799-5952
Mailing Address - Fax:
Practice Address - Street 1:3770 NEW HOPE CHURCH RD
Practice Address - Street 2:
Practice Address - City:PALMERSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38241-5199
Practice Address - Country:US
Practice Address - Phone:731-799-5952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered