Provider Demographics
NPI:1962280446
Name:WHITEHEAD, JENNA
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:WHITEHEAD
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:PO BOX 41
Mailing Address - Street 2:
Mailing Address - City:HOCKLEY
Mailing Address - State:TX
Mailing Address - Zip Code:77447-0041
Mailing Address - Country:US
Mailing Address - Phone:281-755-6572
Mailing Address - Fax:
Practice Address - Street 1:17215 WARREN ST
Practice Address - Street 2:
Practice Address - City:HOCKLEY
Practice Address - State:TX
Practice Address - Zip Code:77447-5378
Practice Address - Country:US
Practice Address - Phone:281-755-6572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education