Healthcare Provider Details

I. General information

NPI: 1346103157
Provider Name (Legal Business Name): 4 CANCER NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1407 STATE ROUTE 89
ASHLAND OH
44805-9763
US

IV. Provider business mailing address

1407 STATE ROUTE 89
ASHLAND OH
44805-9763
US

V. Phone/Fax

Practice location:
  • Phone: 937-269-5397
  • Fax:
Mailing address:
  • Phone: 937-269-5397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1301X
TaxonomyOncology Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: KELLY NELSON
Title or Position: OWNER/DIETITIAN
Credential: MS RD CSO LD
Phone: 937-269-5397