Provider Demographics
NPI:1851963672
Name:PRACTICAL NUTRITION THERAPY LLPC
Entity Type:Organization
Organization Name:PRACTICAL NUTRITION THERAPY LLPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD
Authorized Official - Phone:662-213-7305
Mailing Address - Street 1:2311 LOVITT DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-7228
Mailing Address - Country:US
Mailing Address - Phone:662-213-7305
Mailing Address - Fax:
Practice Address - Street 1:2311 LOVITT DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-7228
Practice Address - Country:US
Practice Address - Phone:662-213-7305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty