Individual
KATIE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1107 SE ARMY POST RD, DES MOINES, IA 50315-5942
(515) 285-6394
Mailing address
5505 XIMINES LN N, PLYMOUTH, MN 55442-1937
(651) 279-4898
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11511142
—
IA
Enumeration date
02/17/2011
Last updated
11/13/2024
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