NPIMap

Organization Active NPI

Lake Norman Nutrition Associates, LLC

  • Registered Dietitian
  • Huntersville, NC
National Provider Identifier
1861534364
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
L001079 Issued in NC
Legal business name
LAKE NORMAN NUTRITION ASSOCIATES, LLC
Doing business as
Lake Norman and Charlotte Nutrition Associates
Practice address
16501 Northcross Dr Ste D
Huntersville, NC 28078-5040
Phone
(704) 895-9865
Fax
(704) 895-9870
NPI assigned
Feb 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Christin Kimberly Wooten, MS,RD,LDN,CDE
Title
Dietitian,Diabetes Educator
Phone
(704) 576-5001

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193400000X SINGLE SPECIALTY GROUP 133V00000X L001079 NC Primary

Addresses

Primary practice location

16501 Northcross Dr Ste D
Huntersville, NC 28078-5040

Mailing address

19809 Northcove Rd # B
Suite 108
Cornelius, NC 28031-6445
Phone (704) 895-9865

Other names 1

  • Lake Norman and Charlotte Nutrition Associates Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Lake Norman and Charlotte Nutrition Associates2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

19809 North Cove Rd
#B
Cornelius, NC 28031

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1861534364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19809 NORTHCOVE RD # B",
            "address_2": "SUITE 108",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280316445",
            "telephone_number": "704-895-9865",
            "fax_number": "704-895-9870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16501 NORTHCROSS DR STE D",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280785040",
            "telephone_number": "704-895-9865",
            "fax_number": "704-895-9870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE NORMAN NUTRITION ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WOOTEN",
        "authorized_official_first_name": "CHRISTIN",
        "authorized_official_middle_name": "KIMBERLY",
        "authorized_official_title_or_position": "DIETITIAN,DIABETES EDUCATOR",
        "authorized_official_telephone_number": "704-576-5001",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MS,RD,LDN,CDE"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": "NC",
            "license": "L001079",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Norman and Charlotte Nutrition Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Huntersville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.