Individual
MISS CRYSTAL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NDTR
Contact information
Practice address
PO BOX 12212, COVINGTON, KY 41012-0212
(918) 732-9506
Mailing address
PO BOX 12212, COVINGTON, KY 41012-0212
(918) 732-9506
Taxonomy
Speciality
Code
Description
License number
State
136A00000X
Registered Dietetic Technician
Primary
86047187
OH
Other
Enumeration date
04/11/2026
Last updated
04/11/2026
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