Provider Demographics
NPI:1720852023
Name:NUTRICARE
Entity Type:Organization
Organization Name:NUTRICARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RD
Authorized Official - Prefix:
Authorized Official - First Name:KEELY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-594-8457
Mailing Address - Street 1:1843 MIDWAY RD
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MS
Mailing Address - Zip Code:39051-7519
Mailing Address - Country:US
Mailing Address - Phone:601-594-8457
Mailing Address - Fax:
Practice Address - Street 1:1840 MIDWAY RD
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MS
Practice Address - Zip Code:39051-7404
Practice Address - Country:US
Practice Address - Phone:601-594-8457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty