Provider Demographics
NPI:1407604630
Name:GROW NOURISHED NUTRITION, LLC
Entity type:Organization
Organization Name:GROW NOURISHED NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, REGISTERED DIETITIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LD, CNSC
Authorized Official - Phone:806-382-3870
Mailing Address - Street 1:7327 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-6473
Mailing Address - Country:US
Mailing Address - Phone:806-382-3870
Mailing Address - Fax:
Practice Address - Street 1:7327 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6473
Practice Address - Country:US
Practice Address - Phone:806-382-3870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty