Individual
KIEONDRA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2801 CRISMAN ST STE 212, CHARLOTTE, NC 28208-3847
(704) 451-4289
Mailing address
2801 CRISMAN ST STE 212, CHARLOTTE, NC 28208-3847
(704) 451-4289
Taxonomy
Speciality
Code
Description
License number
State
171400000X
Health & Wellness Coach
Primary
—
—
172V00000X
Community Health Worker
—
—
174H00000X
Health Educator
—
—
Other
Enumeration date
08/27/2025
Last updated
08/27/2025
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