Individual
MS. JACQUELYN ELAINE WELLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
570 EAST WOODROW WILSON, WIC CENTRAL OFFICE, JACKSON, MS 39215-1700
(601) 987-4666
Mailing address
103 MAGNOLIA WAY, PEARL, MS 39208-3366
(601) 933-4548
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D0594
MS
Other
Enumeration date
03/07/2007
Last updated
07/08/2007
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