National Provider Identifier
Theresa Lynn Jackson, RD
Theresa Lynn Jackson, RD is listed in the NPPES registry with a primary specialty of Registered Dietitian in Kenmore, NY and a listed phone number of (716) 447-6538.
Profile Overview
- NPI
- 1790332443
- Provider Type
- Individual
- Primary Specialty
- Registered Dietitian
- Enumeration Date
- August 19, 2019
- Last Updated
- August 19, 2019
Practice Location
- 2950 Elmwood Ave
- Kenmore, NY 14217-1304
Phone: (716) 447-6538
Mailing Address
- 15 Brookhaven Ln
- Lancaster, NY 14086-9568
Specialties
- Registered Dietitian (133V00000X)
Full Record
- NPI
- 1790332443
- Entity Type
- Individual
- Last Name
- Jackson
- First Name
- Theresa
- Middle Name
- Lynn
- Credential
- RD
- Mailing Street Address
- 15 Brookhaven Ln
- Mailing City
- Lancaster
- Mailing State
- NY
- Mailing ZIP Code
- 14086-9568
- Mailing Country
- US
- Mailing Phone
- (716) 908-1510
- Practice Street Address
- 2950 Elmwood Ave
- Practice City
- Kenmore
- Practice State
- NY
- Practice ZIP Code
- 14217-1304
- Practice Country
- US
- Practice Phone
- (716) 447-6538
- Enumeration Date
- August 19, 2019
- Last Updated
- August 19, 2019
- Sex
- Female
- Sole Proprietor
- No
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Registered Dietitian (133V00000X)