| Doctor Name: | JESSICA JACKSON |
| NPI Number: | 1376823559 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS, RD, LD |
| License Number: | WV #709 |
| Business Practice Address: | 179 Station Place Way Suite 100 Hurricane, WV - 255268747 |
| Business Phone Number: | 3047606300 |
| Business Fax Number: | 3042015123 |
| Mailing Address: | Po Box 450, SCOTT DEPOT |
| State: | WV |
| Postal Code: | 255600450 |
| Phone Number: | 3047606300 |
| Fax Number: | 3042015123 |
| NPI Enumeration Date: | 08/19/2011 |
| NPI Last Update Date: | 08/19/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | WV #709 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WV |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |