MEDICARE: FOUNDATIONS NUTRITION & LIFESTYLE COUNSELING, 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	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1114856036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUNDATIONS NUTRITION & LIFESTYLE COUNSELING, LLC

Provider Business Mailing Address
First Line	:	132 BAYBERRY LN
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-6013
Country	:	US
Telephone Number	:	256-696-0406
Fax Number	:

Provider Business Practice Location Address
First Line	:	132 BAYBERRY LN
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-6013
Country	:	US
Telephone Number	:	256-696-0406
Fax Number	:

Authorized Official
Title or Position	:	DIETITIAN
Name	:	MRS. AMY K MCCORMACK
Credential	:	MS, RD, LDN
Telephone Number	:	256-696-0406

Provider Enumeration Date	:	05/16/2026
Last Update Date	:	06/08/2026

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