| Doctor Name: | TRACIE LEE JACKSON |
| NPI Number: | 1982807715 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RD, LMNT, CDE |
| License Number: | 347 |
| Business Practice Address: | 8601 W Dodge Rd Suite # 30 Omaha, NE - 681143457 |
| Business Phone Number: | 4023548797 |
| Business Fax Number: | 4023545651 |
| Mailing Address: | Po Box 127, HERMAN |
| State: | NE |
| Postal Code: | 680290127 |
| Phone Number: | 4024567876 |
| Fax Number: | |
| NPI Enumeration Date: | 06/08/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | 347 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NE |
| 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 |