Healthcare Provider Details

I. General information

NPI: 1245802115
Provider Name (Legal Business Name): A NUTRIENT IN TIME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 BOUNDRY ST UNIT 101
MINEOLA TX
75773-2305
US

IV. Provider business mailing address

409 BOUNDRY ST UNIT 101
MINEOLA TX
75773-2305
US

V. Phone/Fax

Practice location:
  • Phone: 318-572-6157
  • Fax: 800-708-7349
Mailing address:
  • Phone: 318-572-6157
  • Fax: 800-708-7349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State

VIII. Authorized Official

Name: JULIETTE SHIVERS
Title or Position: DIRECTOR OF NUTRITION
Credential:
Phone: 318-572-6157