Coralcrestnutrition LLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Legal business name

CORALCRESTNUTRITION LLC

Practice address

6297 Jenks Dr
Gulf Breeze, FL 32563-9798

Phone

(850) 339-0728

NPI assigned

Apr 29, 2026

Organization subpart

No

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

Authorized official

Name

Dr. Evetha Malcolm-Theriault, DCN, RD, LDNPI 1659891521

Title

Registered Dietitian

Phone

(850) 339-0728

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.

• Evetha Malcolm-Theriault, RD

  • Registered Dietitian
  • Gulf Breeze, FL
  • NPI 1659891521

  Dietitian, Registered

  NPD Authorized official

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

{
    "created_epoch": "1777420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777420800000",
    "number": "1407793359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3311 GULF BREEZE PKWY # 110",
            "city": "GULF BREEZE",
            "state": "FL",
            "postal_code": "325633351",
            "telephone_number": "850-339-0728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6297 JENKS DR",
            "city": "GULF BREEZE",
            "state": "FL",
            "postal_code": "325639798",
            "telephone_number": "850-339-0728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORALCRESTNUTRITION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-04-29",
        "last_updated": "2026-04-29",
        "certification_date": "2026-04-29",
        "status": "A",
        "authorized_official_last_name": "MALCOLM-THERIAULT",
        "authorized_official_first_name": "EVETHA",
        "authorized_official_title_or_position": "REGISTERED DIETITIAN",
        "authorized_official_telephone_number": "850-339-0728",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DCN, RD, LD"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Registered Dietitian in Gulf Breeze, FL
• Providers in Gulf Breeze, FL by specialty
• Registered Dietitian in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2026; 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.