NPIMap

Organization Active NPI

Lake Norman Nutritition Associates, LLC

  • Registered Dietitian
  • Charlotte, NC
National Provider Identifier
1164556098
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
L001079 Issued in NC
Legal business name
LAKE NORMAN NUTRITITION ASSOCIATES, LLC
Practice address
3535 Randolph Rd
Suite 210
Charlotte, NC 28211-1032
Phone
(704) 895-9865
Fax
(704) 895-9870
NPI assigned
Mar 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Christin Schwarz Wooten, MS,RD,LDN,CDE
Title
Owner and Partner
Phone
(704) 895-9865

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193400000X SINGLE SPECIALTY GROUP 133V00000X L001079 NC Primary

Addresses

Primary practice location

3535 Randolph Rd
Suite 210
Charlotte, NC 28211-1032

Mailing address

19809B Northcove Rd
Suite 108
Cornelius, NC 28031-6445
Phone (704) 895-9865

Other identifiers 2

IdentifierTypeStateIssuer
0154292OtherNCCIGNA
7581332OtherNCAETNA, BCBS

National Provider Directory

National Provider Directory
Tax ID family
Lake Norman and Charlotte Nutrition Associates2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3535 Randolph Rd
Ste 210
Charlotte, NC 28211
Phone (704) 332-5143

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164556098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19809B NORTHCOVE RD",
            "address_2": "SUITE 108",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280316445",
            "telephone_number": "704-895-9865",
            "fax_number": "704-895-9870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 RANDOLPH RD",
            "address_2": "SUITE 210",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282111032",
            "telephone_number": "704-895-9865",
            "fax_number": "704-895-9870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE NORMAN NUTRITITION ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WOOTEN",
        "authorized_official_first_name": "CHRISTIN",
        "authorized_official_middle_name": "SCHWARZ",
        "authorized_official_title_or_position": "OWNER AND PARTNER",
        "authorized_official_telephone_number": "704-895-9865",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MS,RD,LDN,CDE"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": "NC",
            "license": "L001079",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "0154292",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA, BCBS",
            "identifier": "7581332",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.