Provider Demographics
NPI:1164949210
Name:KIDS BEST NUTRITION & HEALTH PLLC
Entity Type:Organization
Organization Name:KIDS BEST NUTRITION & HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:JARVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PNP IBCLC
Authorized Official - Phone:980-533-0993
Mailing Address - Street 1:857 SOUTHWEST DR
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-7909
Mailing Address - Country:US
Mailing Address - Phone:980-533-0993
Mailing Address - Fax:
Practice Address - Street 1:6255 TOWNCENTER DR STE 810
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-9376
Practice Address - Country:US
Practice Address - Phone:980-533-0993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-29
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5000468261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center