At Home Nutrition

Organization Active NPI Registered Dietitian · Clayton, NC

NPI 1093152167 · NPPES record last updated Jul 2, 2013

Key facts

NPI
1093152167
Entity type
Organization (NPI type 2)
Primary specialty
Registered Dietitian 133V00000X
License
L002584 (NC)
Legal business name
AT HOME NUTRITION
Practice address
78 Tuscarora LN
Clayton, NC 27520-7367
Phone
(919) 576-0079
Fax
(919) 516-0917
NPI assigned
May 30, 2013
Organization subpart
No

Authorized official

Name
Mrs. Karen J. Gleason, RD, LDN
Title
Owner/Dietitian
Phone
(919) 257-8480

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in NC

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20130702000610 NC Part B Supplier - Clinic/Group Practice 5496995011 Receives reassigned benefits from 2 practitioners
Practice locations: Clayton, NC

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Nutritionist
Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
133N00000X L002584 NC
Nutrition Education Nutritionist
Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
133NN1002X L002584 NC
Registered Dietitian
Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
133V00000X L002584 NC Yes
Renal Nutrition Registered Dietitian
Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
133VN1005X L002584 NC
Metabolic Nutrition Registered Dietitian
Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
133VN1006X L002584 NC

Addresses

Primary practice location

78 Tuscarora LN
Clayton, NC 27520-7367

Mailing address

78 Tuscarora LN
Clayton, NC 27520-7367
Phone (919) 576-0079

Other providers in Clayton, NC

All providers in Clayton, NC · Registered Dietitian in North Carolina

Sources for this page

Verify at the official NPI Registry.