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General NPI Number Information
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NPI Number | 1164949210
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Entity Type | Organization
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Legal Business Name | KIDS BEST NUTRITION & HEALTH PLLC
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Dates
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Enumeration Date | 08/29/2017
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Last Update Date | 08/29/2017
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Provider Practice Location Address
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Address Line | 6255 TOWNCENTER DR STE 810
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City | CLEMMONS
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State | NC
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Zip | 27012-9376
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Country | US
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Telephone | 980-533-0993
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Fax |
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Provider Business Mailing Address
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Address Line | 857 SOUTHWEST DR
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City | DAVIDSON
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State | NC
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Zip | 28036-7909
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Country | US
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Telephone | 980-533-0993
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Fax |
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Authorized Official
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Title or Position | ORGANIZER/MEMBER
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Name | SANDRA LEE JARVIS
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Credential | PNP IBCLC
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Telephone | 980-533-0993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 5000468
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License Number State | NC
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