Vivid Life Nutrition, LLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

L004256 Issued in NC

Legal business name

VIVID LIFE NUTRITION, LLC

Practice address

1109 N Main St
High Point, NC 27262

Phone

(336) 906-7869

NPI assigned

Apr 7, 2018

Organization subpart

No

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

Authorized official

Name

Mrs. Anna C Hallock, RDN, LDN

Title

Owner

Phone

(336) 906-7869

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Anna Austin, RDN, LDN

  • Registered Dietitian
  • High Point, NC
  • NPI 1104323104

  Dietitian, Registered

  NPD

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

{
    "created_epoch": "1523059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661817600000",
    "number": "1194222109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1109 N MAIN ST",
            "city": "HIGH POINT",
            "state": "NC",
            "postal_code": "272623115",
            "telephone_number": "336-906-7869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1109 N MAIN ST",
            "city": "HIGH POINT",
            "state": "NC",
            "postal_code": "27262",
            "telephone_number": "336-906-7869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIVID LIFE NUTRITION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-07",
        "last_updated": "2022-08-30",
        "certification_date": "2022-08-30",
        "status": "A",
        "authorized_official_last_name": "HALLOCK",
        "authorized_official_first_name": "ANNA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "336-906-7869",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RDN, LDN"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": "NC",
            "license": "L004256",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Village Life Cathedral, Inc
• Vincent L. Brooks DDS,PA
• Elizabeth O'Hare Vinci, CCC-SLP
• Virgil V. Willard, II MD PA
• Kelly Adair Virgil, NP
• Robert Werner Von Dohlen, DDS
• Patrizia Giulia Von Vajna
• W. Earl Barbour, D.C.P.a.
• W.a. Clark D.D.S., P.L.L.C.
• Martha Wadlington

• Registered Dietitian in High Point, NC
• Providers in High Point, NC by specialty
• Registered Dietitian in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2022; 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.