Provider Demographics
NPI:1609628825
Name:PROACTIVE NUTRITION CONSULTING LLC
Entity Type:Organization
Organization Name:PROACTIVE NUTRITION CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:KIERSTON
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CSCS
Authorized Official - Phone:307-331-4206
Mailing Address - Street 1:202 E PERSHING BLVD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-2808
Mailing Address - Country:US
Mailing Address - Phone:307-256-9693
Mailing Address - Fax:307-288-3242
Practice Address - Street 1:202 E PERSHING BLVD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-2808
Practice Address - Country:US
Practice Address - Phone:307-256-9693
Practice Address - Fax:307-288-3242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-02
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight ManagementGroup - Multi-Specialty