Individual
RYAN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MED, RD, LD, CSCS
Contact information
Practice address
2899 ELSINOR DR, FORT WORTH, TX 76116-2707
(816) 726-5716
Mailing address
2899 ELSINOR DR, FORT WORTH, TX 76116-2707
(816) 726-5716
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT86076
TX
Other
Enumeration date
02/19/2026
Last updated
02/19/2026
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