Individual
TRISHA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
904 WOLLARD BLVD, RICHMOND, MO 64085-2229
(816) 470-5432
Mailing address
1208 SW 8TH ST, OAK GROVE, MO 64075-9325
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2004023103
MO
Other
Enumeration date
06/05/2015
Last updated
06/05/2015
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