MEDICARE: ROOTED NUTRITION AND FITNESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133N00000X	Nutritionist

General Provider Information

NPI Number	:	1013840271
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROOTED NUTRITION AND FITNESS LLC

Provider Business Mailing Address
First Line	:	120 BROOMCORN WAY UNIT B
Second Line	:
City	:	HAMPSTEAD
State	:	NC
Zip	:	28443-0649
Country	:	US
Telephone Number	:	910-550-9058
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 BROOMCORN WAY UNIT B
Second Line	:
City	:	HAMPSTEAD
State	:	NC
Zip	:	28443-0649
Country	:	US
Telephone Number	:	910-550-9058
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KELLY BARTON MCGREGOR
Credential	:
Telephone Number	:	910-550-9058

Provider Enumeration Date	:	06/06/2026
Last Update Date	:	06/06/2026

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