Healthcare Provider Details

I. General information

NPI: 1184536690
Provider Name (Legal Business Name): NUTRITIONAL INPUT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 LOUIS NELSON RD
PUEBLO CO
81001-1702
US

IV. Provider business mailing address

78 LOUIS NELSON RD
PUEBLO CO
81001-1702
US

V. Phone/Fax

Practice location:
  • Phone: 719-369-0282
  • Fax:
Mailing address:
  • Phone: 719-369-0282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: KATHY KAY JENSEN
Title or Position: PRESIDENT/OWNER
Credential: MS, RDN
Phone: 719-369-0282