Provider Demographics
NPI:1447917422
Name:MY NUTRITION, LLC.
Entity type:Organization
Organization Name:MY NUTRITION, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:936-355-2484
Mailing Address - Street 1:217 E MAIN ST STE 1094
Mailing Address - Street 2:
Mailing Address - City:ROYSE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75189-9998
Mailing Address - Country:US
Mailing Address - Phone:936-355-2484
Mailing Address - Fax:
Practice Address - Street 1:8570 COUNTRY RD 589
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:TX
Practice Address - Zip Code:75173
Practice Address - Country:US
Practice Address - Phone:936-355-2484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty