Healthcare Provider Details

I. General information

NPI: 1871290940
Provider Name (Legal Business Name): THE KIDNEY NUTRITION COACH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 N HIGH ST STE 207
WORTHINGTON OH
43085-2370
US

IV. Provider business mailing address

7100 N HIGH ST STE 207
WORTHINGTON OH
43085-2370
US

V. Phone/Fax

Practice location:
  • Phone: 520-249-1308
  • Fax:
Mailing address:
  • Phone: 520-249-1308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: SUMMER VAN ARSDALE
Title or Position: DIETITIAN
Credential: RD
Phone: 520-249-1308