Healthcare Provider Details

I. General information

NPI: 1447006192
Provider Name (Legal Business Name): KIDS IN PURSUIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3324 RIVER DR
COLUMBIA SC
29201-1305
US

IV. Provider business mailing address

3324 RIVER DR
COLUMBIA SC
29201-1305
US

V. Phone/Fax

Practice location:
  • Phone: 919-412-7746
  • Fax:
Mailing address:
  • Phone: 919-412-7746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: CARLA RAE NOWICKI
Title or Position: CEO
Credential: RD
Phone: 919-412-7746