Healthcare Provider Details

I. General information

NPI: 1871392795
Provider Name (Legal Business Name): ROSS NUTRITION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2025
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 GENESEE ST
UTICA NY
13501-5942
US

IV. Provider business mailing address

7026 DATE PALM LN
ELLENTON FL
34222-4316
US

V. Phone/Fax

Practice location:
  • Phone: 877-510-5562
  • Fax:
Mailing address:
  • Phone: 941-234-4541
  • Fax: 941-213-5822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: DR. KIM ROSS
Title or Position: DOCTOR OF CLINICAL NUTRITION
Credential: DCN, CNS, LDN
Phone: 941-234-4541