NPIMap

Organization Active NPI

Custom Nutrition & Wellness LLC

  • Registered Dietitian
  • Cullowhee, NC
National Provider Identifier
1538768577
Registry record updated Oct 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 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
Last updated
Oct 21, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2020

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

Authorized official

Name
Krystle T Holt, MHS RDN LDN ACSM-CPTNPI 1669828885
Title
Owner
Phone
(910) 231-7589

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

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

Addresses

Primary practice location

594 Centennial Dr
Cullowhee, NC 28723-1589

Mailing address

745 Holly Hills Rd
Sylva, NC 28779-6964

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 32

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 32

NPI Registry JSON

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

{
    "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

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 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.