Crystal Jackson, NDTR

Primary specialty

Registered Dietetic TechnicianTaxonomy code 136A00000X

License

86047187 Issued in OH

Practice address

PO Box 12212
Covington, KY 41012-0212

Phone

(918) 732-9506

NPI assigned

Apr 11, 2026

Last updated

Apr 11, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1775865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775865600000",
    "number": "1154264471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12212",
            "city": "COVINGTON",
            "state": "KY",
            "postal_code": "410120212",
            "telephone_number": "918-732-9506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PO BOX 12212",
            "city": "COVINGTON",
            "state": "KY",
            "postal_code": "410120212",
            "telephone_number": "918-732-9506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CRYSTAL",
        "name_prefix": "Miss",
        "credential": "NDTR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-04-11",
        "last_updated": "2026-04-11",
        "certification_date": "2026-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "136A00000X",
            "taxonomy_group": "",
            "desc": "Dietetic Technician, Registered",
            "state": "OH",
            "license": "86047187",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Courtney Huntley, PHARMD
• Sean Hyland
• Suzanne Marie Ingle, MS, CCC-SLP
• Danielle Ingram Farris, B.A.
• Lara Brooke Ingram, MSW
• Laura K Jackson, LCSW; LCDC III
• Tracie R Jackson, PRS
• Jay and Marsha Millard Foundation
• Kimberlee Dawn Jerles, LMT
• Deaira Jett

• Registered Dietetic Technician in Covington, KY
• Providers in Covington, KY by specialty
• Registered Dietetic Technician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.