Jennifer Elise Lopez, MS, RDN, LD
Individual provider Active NPI Registered Dietitian · Paradise, TX
NPI 1346794286 · NPPES record last updated Apr 16, 2024
Key facts
- NPI
- 1346794286
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- DT83661 (TX)
- Practice address
- 1041 Sunflower
Paradise, TX 76073-3219 - Phone
- (682) 554-5708
- Fax
- (940) 828-1460
- NPI assigned
- Aug 9, 2016
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161205002298 | TX | Practitioner - Registered Dietitian Or Nutrition Professional | 3779863972 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DT83661 | TX | MD | Registered Dietitian |
| 21700275 | TX | MD | Diabetes Educator Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Access Wellness Resources | Current |
Accepting new patients | |
| David N Podgurecki, MD PA | Past | Accepting new patients | |
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
Locations
1305 Airport Fwy
Ste 405
Bedford, TX 76021
Phone (817) 595-4949
6029 Belt Line Rd
Ste 105
Dallas, TX 75254
Phone (972) 385-0000
2720 Western Center Blvd
Ste 312
Fort Worth, TX 76131
Phone (817) 847-0200
1625 N Grand Ave
Gainesville, TX 76240
Phone (940) 382-6757
1604 Lancaster Dr
Grapevine, TX 76051
Phone (817) 481-8661
4004 Medical Pkwy
Greenville, TX 75401
Phone (214) 771-3668
1752 Broad Park Cir N
Ste 114
Mansfield, TX 76063
Phone (817) 405-9974
710 E Anderson St
Ste 101
Weatherford, TX 76086
Phone (817) 489-5778
Interoperability endpoints
- https://api.platform.athenahealth.com/27041/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | DT83661 | TX | Yes |
| Diabetes Educator Registered Nurse | 163WD0400X | 21700275 | TX |
Addresses
Primary practice location
1041 Sunflower
Paradise, TX 76073-3219
Mailing address
1041 Sunflower
Paradise, TX 76073-3219
Phone (682) 554-5708
Other providers in Paradise, TX
- Chrystal Eustace
- Felicia Gentry
- Samantha Hayes
- Jennifer Lopez, Rd, PLLC
- Rebecca Lawson
- Jadon Maddux
- Jackie Nixon-Fulton
- Paradise Counseling & Wellness Center
- Paradise Isd
- Katlyn Marie Powell
All providers in Paradise, TX · Registered Dietitian in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 16, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.