Provider Demographics
NPI:1942010228
Name:WELL-NOURISHED NUTRITION LLC
Entity type:Organization
Organization Name:WELL-NOURISHED NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:859-285-6485
Mailing Address - Street 1:3070 LAKECREST CIR STE 400-117
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1937
Mailing Address - Country:US
Mailing Address - Phone:859-285-6485
Mailing Address - Fax:
Practice Address - Street 1:424 LEWIS HARGETT CIR
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3688
Practice Address - Country:US
Practice Address - Phone:859-285-6485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-09
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty