Provider Demographics
NPI:1063734226
Name:TRACY ROGERS NUTRITION CONSULTING INC.
Entity type:Organization
Organization Name:TRACY ROGERS NUTRITION CONSULTING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MS,RD,LDN
Authorized Official - Phone:252-241-0369
Mailing Address - Street 1:209 N 35TH ST
Mailing Address - Street 2:SUITE B-3
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-3183
Mailing Address - Country:US
Mailing Address - Phone:252-241-0369
Mailing Address - Fax:888-813-7814
Practice Address - Street 1:209 N 35TH ST
Practice Address - Street 2:SUITE B-3
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-3183
Practice Address - Country:US
Practice Address - Phone:252-241-0369
Practice Address - Fax:888-813-7814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-15
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002454133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty