Organization
JACLYN POWELL NUTRITION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACLYN POWELL MS, RD, CEDRD-S (OWNER/RD)
(720) 341-5598
Entity
Organization
Contact information
Practice address
160 SPRING MEADOW LN, KESWICK, VA 22947-3251
(720) 341-5598
Mailing address
160 SPRING MEADOW LN, KESWICK, VA 22947-3251
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1699223941
—
VA
Enumeration date
10/07/2022
Last updated
10/07/2022
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