Individual
MS. JERILYN ANN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
111 BREWSTER ST, PAWTUCKET, RI 02860-4400
(401) 729-2360
(401) 729-2179
Mailing address
111 BREWSTER ST, PAWTUCKET, RI 02860-4400
(401) 729-2360
(401) 729-2179
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LDN00388
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2038776
UNITED HEALTH CARE
RI
01
—
20695-0
BLUE CROSS
RI
01
—
CP00404528
BLUE CHIP
RI
Enumeration date
07/06/2006
Last updated
07/08/2007
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