Provider Demographics
NPI:1659119303
Name:CAPITAL NUTRITION SERVICES, LLC
Entity type:Organization
Organization Name:CAPITAL NUTRITION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LD
Authorized Official - Phone:706-415-7249
Mailing Address - Street 1:3412 GALLANT FOX TRL
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-1710
Mailing Address - Country:US
Mailing Address - Phone:706-415-7249
Mailing Address - Fax:850-616-0884
Practice Address - Street 1:3412 GALLANT FOX TRL
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-1710
Practice Address - Country:US
Practice Address - Phone:706-415-7249
Practice Address - Fax:850-616-0884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty