Healthcare Provider Details

I. General information

NPI: 1114643046
Provider Name (Legal Business Name): CATALYST NUTRITION AND TRAINING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 PIERCE ST STE 201
KINGSTON PA
18704-5512
US

IV. Provider business mailing address

7 ASTER RD
DALLAS PA
18612-9759
US

V. Phone/Fax

Practice location:
  • Phone: 888-862-0803
  • Fax: 888-862-0803
Mailing address:
  • Phone: 570-406-5375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BROOKE MICHELLE EVANS
Title or Position: OWNER
Credential: RD
Phone: 888-862-0803