Provider Demographics
NPI:1174350664
Name:GRIERSON, JENNIFER (REGISTERED DIETITIAN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:GRIERSON
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1339 BATEMAN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39339-5938
Mailing Address - Country:US
Mailing Address - Phone:662-820-2346
Mailing Address - Fax:
Practice Address - Street 1:1339 BATEMAN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:MS
Practice Address - Zip Code:39339-5938
Practice Address - Country:US
Practice Address - Phone:662-820-2346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1142133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered