Individual
MRS. JACQUELINE DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDN, LDN, IBCLC
Contact information
Practice address
371 NC HIGHWAY 65, REIDSVILLE, NC 27320-8881
(336) 342-8201
Mailing address
371 NC HIGHWAY 65, REIDSVILLE, NC 27320-8881
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
96253419
NC
174N00000X
Lactation Consultant (Non-RN)
L-122675
NC
Other
Enumeration date
03/18/2025
Last updated
03/18/2025
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