Provider Demographics
NPI:1689420200
Name:SCHARF, JACKSON (RD, LD)
Entity type:Individual
Prefix:
First Name:JACKSON
Middle Name:
Last Name:SCHARF
Suffix:
Gender:M
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 ISLEWORTH DR APT 4304
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-1685
Mailing Address - Country:US
Mailing Address - Phone:432-661-5778
Mailing Address - Fax:
Practice Address - Street 1:4000 ISLEWORTH DR APT 4304
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-1685
Practice Address - Country:US
Practice Address - Phone:432-661-5778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-25
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4878133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered