Provider Demographics
NPI:1770107948
Name:BIG HORN NUTRITION, LLC
Entity type:Organization
Organization Name:BIG HORN NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TENIKA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:EARDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:307-679-4639
Mailing Address - Street 1:1351 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:GREYBULL
Mailing Address - State:WY
Mailing Address - Zip Code:82426-1504
Mailing Address - Country:US
Mailing Address - Phone:307-679-4639
Mailing Address - Fax:
Practice Address - Street 1:1351 N 8TH ST
Practice Address - Street 2:
Practice Address - City:GREYBULL
Practice Address - State:WY
Practice Address - Zip Code:82426-1504
Practice Address - Country:US
Practice Address - Phone:307-679-4639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty