Wildcrafted Wellness LLC

Primary specialty

NutritionistTaxonomy code 133N00000X

Legal business name

WILDCRAFTED WELLNESS LLC

Practice address

5415 W Cedar LN Ste 202a
Bethesda, MD 20814-1515

Phone

(301) 530-0800

NPI assigned

Feb 11, 2020

Organization subpart

No

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

Authorized official

Name

Kaitlin Marie Costello, CNSNPI 1699127464

Title

Nutritionist

Phone

(410) 688-9009

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.

• Kaitlin Marie Costello, CNS, LDN

  • Nutritionist
  • Washington, DC
  • NPI 1699127464
  NPD Authorized official

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

{
    "created_epoch": "1581379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581379200000",
    "number": "1801428412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7010 CHERRY AVE",
            "city": "TAKOMA PARK",
            "state": "MD",
            "postal_code": "209126445",
            "telephone_number": "410-688-9009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5415 W CEDAR LN STE 202A",
            "city": "BETHESDA",
            "state": "MD",
            "postal_code": "208141515",
            "telephone_number": "301-530-0800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILDCRAFTED WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-11",
        "last_updated": "2020-02-11",
        "certification_date": "2020-02-11",
        "status": "A",
        "authorized_official_last_name": "COSTELLO",
        "authorized_official_first_name": "KAITLIN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "NUTRITIONIST",
        "authorized_official_telephone_number": "410-688-9009",
        "authorized_official_credential": "CNS"
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nutritionist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Scott J Wiesenberger, MD
• Timothy Joseph Wiess, DO
• Adrian Urban Wiestner
• Shaconya Lafaye Wiggins, OTRL
• Sarah Louise Wigmore, MOTR/L
• David Brian Wilde, M.D.
• Jay Scott Wilder, M.D.
• Jennifer Wilder, RN
• Jessica Wilder
• Ronald Lynn Wilder, M.D.

• Nutritionist in Bethesda, MD
• Providers in Bethesda, MD by specialty
• Nutritionist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 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.