Healthcare Provider Details

I. General information

NPI: 1205691391
Provider Name (Legal Business Name): HAIRSTON NUTRITION CONSULTING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2024
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6802 PARAGON PL STE 410
RICHMOND VA
23230-1655
US

IV. Provider business mailing address

PO BOX 777698
HENDERSON NV
89077-7698
US

V. Phone/Fax

Practice location:
  • Phone: 725-599-3080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL HAIRSTON JR.
Title or Position: PRESIDENT
Credential: RDN
Phone: 725-599-3080