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Custom Nutrition & Wellness LLC

Organization Active NPI Registered Dietitian · Cullowhee, NC

NPI 1538768577 · NPPES record last updated Oct 21, 2020

Key facts

NPI
1538768577
Entity type
Organization (NPI type 2)
Primary specialty
Registered Dietitian 133V00000X
Legal business name
CUSTOM NUTRITION & WELLNESS LLC
Practice address
594 Centennial Dr
Cullowhee, NC 28723-1589
Phone
(828) 330-9903
Fax
(833) 492-5875
NPI assigned
Oct 21, 2020
Organization subpart
No

Authorized official

Name
Krystle T Holt, MHS RDN LDN ACSM-CPT
Title
Owner
Phone
(910) 231-7589

Practitioners 31

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

View all 31

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian
Group: 193400000X SINGLE SPECIALTY GROUP		 133V00000X Yes

Addresses

Primary practice location

594 Centennial Dr
Cullowhee, NC 28723-1589

Mailing address

745 Holly Hills Rd
Sylva, NC 28779-6964

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 21, 2020.

{
    "created_epoch": "1603238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603238400000",
    "number": "1538768577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "745 HOLLY HILLS RD",
            "city": "SYLVA",
            "state": "NC",
            "postal_code": "287796964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "594 CENTENNIAL DR",
            "city": "CULLOWHEE",
            "state": "NC",
            "postal_code": "287231589",
            "telephone_number": "828-330-9903",
            "fax_number": "833-492-5875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOM NUTRITION & WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-21",
        "last_updated": "2020-10-21",
        "certification_date": "2020-10-21",
        "status": "A",
        "authorized_official_last_name": "HOLT",
        "authorized_official_first_name": "KRYSTLE",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "910-231-7589",
        "authorized_official_credential": "MHS RDN LDN ACSM-CPT"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cullowhee, NC

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

Sources for this page

Verify at the official NPI Registry.