Provider Demographics
NPI:1447507702
Name:NUTRITION SENSE
Entity type:Organization
Organization Name:NUTRITION SENSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:210-415-0165
Mailing Address - Street 1:265 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-2035
Mailing Address - Country:US
Mailing Address - Phone:210-415-0165
Mailing Address - Fax:
Practice Address - Street 1:110 DOVE CREST DR
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-7828
Practice Address - Country:US
Practice Address - Phone:210-415-0165
Practice Address - Fax:888-512-4765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT04664133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB127190OtherMEDICARE PTAN