MEDICARE: TRACY ROGERS NUTRITION CONSULTING INC.

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	133V00000X	Registered Dietitian	L002454	NC

General Provider Information

NPI Number	:	1063734226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRACY ROGERS NUTRITION CONSULTING INC.

Provider Business Mailing Address
First Line	:	209 N 35TH ST
Second Line	:	SUITE B-3
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-3183
Country	:	US
Telephone Number	:	252-241-0369
Fax Number	:	888-813-7814

Provider Business Practice Location Address
First Line	:	209 N 35TH ST
Second Line	:	SUITE B-3
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-3183
Country	:	US
Telephone Number	:	252-241-0369
Fax Number	:	888-813-7814

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. TRACY C ROGERS
Credential	:	MS,RD,LDN
Telephone Number	:	252-241-0369

Provider Enumeration Date	:	02/15/2010
Last Update Date	:	02/15/2010

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