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General NPI Number Information
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NPI Number | 1013840271
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Entity Type | Organization
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Legal Business Name | ROOTED NUTRITION AND FITNESS LLC
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Dates
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Enumeration Date | 06/06/2026
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Last Update Date | 06/06/2026
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Provider Practice Location Address
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Address Line | 120 BROOMCORN WAY UNIT B
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City | HAMPSTEAD
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State | NC
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Zip | 28443-0649
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Country | US
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Telephone | 910-550-9058
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Fax |
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Provider Business Mailing Address
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Address Line | 120 BROOMCORN WAY UNIT B
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City | HAMPSTEAD
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State | NC
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Zip | 28443-0649
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Country | US
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Telephone | 910-550-9058
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KELLY BARTON MCGREGOR
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Credential |
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Telephone | 910-550-9058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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