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Contact Information

CRYSTAL JACKSON, NDTR
PO BOX 12212
COVINGTON, KY41012-0212
 Phone: 918-732-9506
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dietetic Technician, Registered

136A00000X
Indicates primary specialty

NPI Profile & details for CRYSTAL JACKSON · (Female)

NPI Number 1154264471
Status Active
Credentials NDTR
Entity Individual
Enumeration date 04/11/2026
Last updated 04/11/2026 - About 2 months ago
Sole proprietor 1 No
Identifiers
  • OH License # 86047187
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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