Provider Demographics
NPI:1679086730
Name:ANTONY, JENNY HUDSON (MS,RD,LD)
Entity type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:HUDSON
Last Name:ANTONY
Suffix:
Gender:F
Credentials:MS,RD,LD
Other - Prefix:MISS
Other - First Name:JENNY
Other - Middle Name:LYNN
Other - Last Name:HUDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,RD,LD
Mailing Address - Street 1:6431 FANNIN STREET
Mailing Address - Street 2:MSB 3.146A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:713-500-5906
Mailing Address - Fax:713-383-1475
Practice Address - Street 1:6410 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3000
Practice Address - Country:US
Practice Address - Phone:713-500-5906
Practice Address - Fax:713-383-1475
Is Sole Proprietor?:No
Enumeration Date:2017-11-13
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83514133V00000X, 133VN1004X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT83514OtherCOMMISSION ON DIETETIC REGISTRATION