Provider Demographics
NPI:1831405125
Name:BOVE, JACQUELYN NICOLE (RD, LD)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:NICOLE
Last Name:BOVE
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 N COBB ST
Mailing Address - Street 2:EDUCATION DEPT
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-2343
Mailing Address - Country:US
Mailing Address - Phone:478-457-2300
Mailing Address - Fax:478-454-3934
Practice Address - Street 1:821 N COBB ST
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2343
Practice Address - Country:US
Practice Address - Phone:478-457-2300
Practice Address - Fax:478-454-3934
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003581133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered