Provider Demographics
NPI:1053185025
Name:FEED YOUR ZEST NUTRITION & WELLNESS, LLC
Entity type:Organization
Organization Name:FEED YOUR ZEST NUTRITION & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MCKENZIE
Authorized Official - Middle Name:GABRIELLE
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, RDN
Authorized Official - Phone:704-916-9329
Mailing Address - Street 1:933 LOUISE AVE # 485
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2147
Mailing Address - Country:US
Mailing Address - Phone:704-916-9329
Mailing Address - Fax:980-422-0173
Practice Address - Street 1:933 LOUISE AVE # 485
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2147
Practice Address - Country:US
Practice Address - Phone:704-916-9329
Practice Address - Fax:980-422-0173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty