Provider Demographics
NPI:1558889378
Name:BRITTYN COLEMAN NUTRITION
Entity Type:Organization
Organization Name:BRITTYN COLEMAN NUTRITION
Other - Org Name:BRITTYN HOWARD NUTRITIONAL COUNSELING
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRITTYN
Authorized Official - Middle Name:B
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN/LD
Authorized Official - Phone:303-335-9752
Mailing Address - Street 1:2845 LINKS DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1597
Mailing Address - Country:US
Mailing Address - Phone:303-335-9752
Mailing Address - Fax:415-991-8114
Practice Address - Street 1:2101 PEARL ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-4552
Practice Address - Country:US
Practice Address - Phone:303-335-9752
Practice Address - Fax:415-991-8114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-31
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2110133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200635790AMedicaid
OK679960OtherBLUE CROSS BLUE SHIELD OF OKLAHOMA
OK1030912OtherHEALTHCHOICE OF OKLAHOMA