Healthcare Provider Details

I. General information

NPI: 1093682171
Provider Name (Legal Business Name): LAUREN MCKNIGHT-FORD RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2025
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 E 7TH ST
CHARLOTTE NC
28204-4318
US

IV. Provider business mailing address

12408 MCALLISTER PARK DR
CHARLOTTE NC
28277-2495
US

V. Phone/Fax

Practice location:
  • Phone: 248-320-3448
  • Fax:
Mailing address:
  • Phone: 248-320-3448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License NumberL005924
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: