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General NPI Number Information
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NPI Number | 1235583873
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Entity Type | Organization
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Legal Business Name | NUTRITION SOLUTIONS
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Dates
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Enumeration Date | 04/20/2016
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Last Update Date | 04/20/2016
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Provider Practice Location Address
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Address Line | 990 INTERSTATE 10 N SUITE 215
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City | BEAUMONT
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State | TX
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Zip | 77702-1051
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Country | US
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Telephone | 409-454-0417
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Fax | 888-977-1202
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Provider Business Mailing Address
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Address Line | 990 INTERSTATE 10 N SUITE 215
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City | BEAUMONT
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State | TX
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Zip | 77702-1051
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Country | US
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Telephone |
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Fax | 888-977-1202
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KELLILYN WORLEY
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Credential | MS, RDN, LD
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Telephone | 409-454-0417
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | DT06620
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License Number State | TX
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