MEDICARE: NUTRITION EMPOWERED, 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	261QH0100X	Health Service Clinic/Center
2	133V00000X	Registered Dietitian

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	86175731	OTHER		CDR ID

General Provider Information

NPI Number	:	1073260113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUTRITION EMPOWERED, LLC

Provider Business Mailing Address
First Line	:	4182 WORTH AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-1535
Country	:	US
Telephone Number	:	614-300-0116
Fax Number	:	614-455-9311

Provider Business Practice Location Address
First Line	:	4182 WORTH AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-1535
Country	:	US
Telephone Number	:	614-300-0116
Fax Number	:	614-455-9311

Authorized Official
Title or Position	:	CO-OWNER
Name	:	MISS COLLEEN ELIZABETH BAILEY
Credential	:	MS, RDN, LD
Telephone Number	:	614-300-0116

Provider Enumeration Date	:	03/08/2022
Last Update Date	:	05/30/2025

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Directions to “NUTRITION EMPOWERED, LLC ” Practice Location

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