Provider Demographics
NPI:1649569336
Name:URBAN NUTRITION, LLC
Entity Type:Organization
Organization Name:URBAN NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:JULSTEDT
Authorized Official - Last Name:COFFEE
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:817-366-4643
Mailing Address - Street 1:1209 TIMBER CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-9225
Mailing Address - Country:US
Mailing Address - Phone:817-366-4643
Mailing Address - Fax:
Practice Address - Street 1:1209 TIMBER CT
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-9225
Practice Address - Country:US
Practice Address - Phone:817-366-4643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-03
Last Update Date:2011-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81448133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty