Provider Demographics
NPI:1669781340
Name:ARMOLT, JENNIFER CHRISTIN (REGISTERED DIETITIAN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CHRISTIN
Last Name:ARMOLT
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:CHRISTIN
Other - Last Name:WICKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED DIETITIAN
Mailing Address - Street 1:4815 ROSE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35475-5950
Mailing Address - Country:US
Mailing Address - Phone:334-530-9254
Mailing Address - Fax:
Practice Address - Street 1:4815 ROSE BLVD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35475-5950
Practice Address - Country:US
Practice Address - Phone:334-530-9254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLD2101133V00000X
GALD002620133V00000X
AL945225133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered