Provider Demographics
NPI:1053282277
Name:RENEW U NUTRITION LLC
Entity type:Organization
Organization Name:RENEW U NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:KAYLENE
Authorized Official - Last Name:HUMPHREYS
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:580-272-7689
Mailing Address - Street 1:52984 423RD AVE
Mailing Address - Street 2:
Mailing Address - City:TALIHINA
Mailing Address - State:OK
Mailing Address - Zip Code:74571-2053
Mailing Address - Country:US
Mailing Address - Phone:580-272-7689
Mailing Address - Fax:580-219-7046
Practice Address - Street 1:52984 423RD AVE
Practice Address - Street 2:
Practice Address - City:TALIHINA
Practice Address - State:OK
Practice Address - Zip Code:74571-2053
Practice Address - Country:US
Practice Address - Phone:580-272-7689
Practice Address - Fax:580-219-7046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-12
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty