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General NPI Number Information
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NPI Number | 1740098144
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Entity Type | Organization
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Legal Business Name | NOURISHED ROOTS LLC
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Dates
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Enumeration Date | 12/19/2024
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Last Update Date | 06/18/2026
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Provider Practice Location Address
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Address Line | 5900 BALCONES DR # 8390
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City | AUSTIN
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State | TX
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Zip | 78731-4257
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Country | US
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Telephone | 214-907-0721
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Fax |
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Provider Business Mailing Address
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Address Line | 5900 BALCONES DR # 8390
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City | AUSTIN
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State | TX
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Zip | 78731-4257
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Country | US
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Telephone | 469-626-8094
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Fax | 214-613-4005
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Authorized Official
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Title or Position | CEO
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Name | MISS JAMALA CHRISTOPHER
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Credential | MCN, RD, LD
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Telephone | 214-907-0721
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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 |
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License Number State |
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