Healthcare Provider Details

I. General information

NPI: 1013840271
Provider Name (Legal Business Name): ROOTED NUTRITION AND FITNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2026
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 BROOMCORN WAY UNIT B
HAMPSTEAD NC
28443-0649
US

IV. Provider business mailing address

120 BROOMCORN WAY UNIT B
HAMPSTEAD NC
28443-0649
US

V. Phone/Fax

Practice location:
  • Phone: 910-550-9058
  • Fax:
Mailing address:
  • Phone: 910-550-9058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name: KELLY BARTON MCGREGOR
Title or Position: OWNER
Credential:
Phone: 910-550-9058