MEDICARE: ERIN JACKSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1306705900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN JACKSON

Provider Business Mailing Address
First Line	:	3724 JEFFERSON ST STE 104
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-6204
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4735 MORAGA AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-1734
Country	:	US
Telephone Number	:	619-243-9627
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2026
Last Update Date	:	01/19/2026

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