Provider Demographics
NPI:1891381968
Name:SHARON PHILLIPS NUTRITION, LLC
Entity Type:Organization
Organization Name:SHARON PHILLIPS NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:931-436-8187
Mailing Address - Street 1:7769 E LYONS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66441-7829
Mailing Address - Country:US
Mailing Address - Phone:931-436-8187
Mailing Address - Fax:
Practice Address - Street 1:7769 E LYONS CREEK RD
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66441-7829
Practice Address - Country:US
Practice Address - Phone:931-436-8187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty