Provider Demographics
NPI:1609220805
Name:SUMNER NUTRITION
Entity Type:Organization
Organization Name:SUMNER NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMNER
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:281-516-8661
Mailing Address - Street 1:14507 LOGAN FALLS LN
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-3774
Mailing Address - Country:US
Mailing Address - Phone:281-516-8661
Mailing Address - Fax:
Practice Address - Street 1:14507 LOGAN FALLS LN
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-3774
Practice Address - Country:US
Practice Address - Phone:281-516-8661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06413133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty