Provider Demographics
NPI:1952811077
Name:NOURISHING MINDS NUTRITION
Entity Type:Organization
Organization Name:NOURISHING MINDS NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:CANTLON
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:830-265-8004
Mailing Address - Street 1:2861 40TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-2240
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2861 40TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-2240
Practice Address - Country:US
Practice Address - Phone:704-640-8102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty