Provider Demographics
NPI:1497399851
Name:NUTRICADDY LLC
Entity Type:Organization
Organization Name:NUTRICADDY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL NUTRITION MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NETRO
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKAY
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:832-477-4777
Mailing Address - Street 1:14 GREENWAY PLZ UNIT 13O
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046-1421
Mailing Address - Country:US
Mailing Address - Phone:832-477-4777
Mailing Address - Fax:
Practice Address - Street 1:14 GREENWAY PLZ UNIT 13O
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77046-1421
Practice Address - Country:US
Practice Address - Phone:832-477-4777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV39630-DIE-0OtherDEPARTMENT OF HEALTH AND HUMAN SERVICES
TXDT84107OtherTEXAS DEPARTMENT OF LICENSING AND REGULATION
NCL005942OtherNORTH CAROLINA BOARD OF DIETETICS