Provider Demographics
NPI:1265895148
Name:NUTRITION SPECIALIST
Entity type:Organization
Organization Name:NUTRITION SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER; MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:LORAINE
Authorized Official - Last Name:GROUT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, CSSD, LD/N
Authorized Official - Phone:502-526-8766
Mailing Address - Street 1:2321 LIME KILN LN
Mailing Address - Street 2:UNIT B
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-3410
Mailing Address - Country:US
Mailing Address - Phone:502-526-8766
Mailing Address - Fax:888-972-1620
Practice Address - Street 1:2321 LIME KILN LN
Practice Address - Street 2:UNIT B
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-3410
Practice Address - Country:US
Practice Address - Phone:502-526-8766
Practice Address - Fax:888-972-1620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty