Provider Demographics
NPI:1942695200
Name:JACKSON, ASHTON (RDN)
Entity Type:Individual
Prefix:
First Name:ASHTON
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5324 MCFARLAND RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-6865
Mailing Address - Country:US
Mailing Address - Phone:919-354-7077
Mailing Address - Fax:919-354-7075
Practice Address - Street 1:5324 MCFARLAND RD
Practice Address - Street 2:SUITE 150
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6865
Practice Address - Country:US
Practice Address - Phone:919-354-7077
Practice Address - Fax:919-354-7075
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004579133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered