Individual
MRS. SHANNON BYRD JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LDN
Contact information
Practice address
1705 TARBORO ST SW, WILSON, NC 27893-3428
(252) 399-8768
(252) 399-7494
Mailing address
1705 TARBORO ST SW, WILSON, NC 27893-3428
(252) 399-8768
(252) 399-7494
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
L002445
NC
Other
Enumeration date
10/14/2010
Last updated
10/14/2010
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