Provider Demographics
NPI:1386144434
Name:JONES, WANDA (MS, ID, RD, PHARMD)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:MS, ID, RD, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26113 CHIVALRY CT
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-1461
Mailing Address - Country:US
Mailing Address - Phone:832-639-4066
Mailing Address - Fax:
Practice Address - Street 1:26113 CHIVALRY CT
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-1461
Practice Address - Country:US
Practice Address - Phone:832-639-4066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT80881133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist