Individual
KAYLEE JACKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, RD, CSSD, LD
Contact information
Practice address
2600 COLE AVE APT 104, DALLAS, TX 75204-0948
(404) 702-2687
Mailing address
2600 COLE AVE APT 104, DALLAS, TX 75204-0948
(404) 702-2687
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT84830
TX
Other
Enumeration date
11/20/2023
Last updated
11/20/2023
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