MEDICARE: IRON HEART NUTRITION 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	:	1790668226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IRON HEART NUTRITION LLC

Provider Business Mailing Address
First Line	:	1402 1/2 N 32ND ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-6716
Country	:	US
Telephone Number	:	804-385-6002
Fax Number	:

Provider Business Practice Location Address
First Line	:	2522 HERMITAGE RD STE D
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-1129
Country	:	US
Telephone Number	:	804-385-6002
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JACOB CLAY FRALIN
Credential	:	RD
Telephone Number	:	804-385-6002

Provider Enumeration Date	:	07/30/2025
Last Update Date	:	07/30/2025

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