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General NPI Number Information
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NPI Number | 1841131596
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Entity Type | Organization
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Legal Business Name | CRYSTAL CLEAR NUTRITION LLC
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Dates
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Enumeration Date | 04/04/2026
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Last Update Date | 04/04/2026
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Provider Practice Location Address
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Address Line | 244 W STATESVILLE AVE
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City | MOORESVILLE
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State | NC
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Zip | 28115-2284
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Country | US
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Telephone | 607-591-7852
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Fax |
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Provider Business Mailing Address
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Address Line | 244 W STATESVILLE AVE
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City | MOORESVILLE
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State | NC
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Zip | 28115-2284
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Country | US
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Telephone | 607-591-7852
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Fax |
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Authorized Official
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Title or Position | DIETITIAN
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Name | CRYSTAL NICOLE JOYCE JONES
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Credential | MS, RDN, LDN
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Telephone | 607-591-7852
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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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