Provider Demographics
NPI:1467257709
Name:SARAH POLK NUTRITION, LLC
Entity type:Organization
Organization Name:SARAH POLK NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:POLK
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD, CSOWM
Authorized Official - Phone:314-246-9072
Mailing Address - Street 1:4134 QUINCY ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-2705
Mailing Address - Country:US
Mailing Address - Phone:636-577-1686
Mailing Address - Fax:
Practice Address - Street 1:10004 KENNERLY RD STE 370A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-5118
Practice Address - Country:US
Practice Address - Phone:314-246-9072
Practice Address - Fax:314-627-7007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-18
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty