NPIMap

Organization Active NPI

Life Styles Nutrition Services

  • Registered Dietitian
  • Grand Rapids, MI
National Provider Identifier
1902009475
Registry record updated Jun 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
723477 Issued in MI
Legal business name
LIFE STYLES NUTRITION SERVICES
Practice address
1550 Giddings Ave SE
Grand Rapids, MI 49507
Phone
(616) 560-5696
NPI assigned
Jun 11, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2018

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

Authorized official

Name
Ms. Tracy Marie Booth, R.D.NNPI 1124094321
Title
Independent Contractor & Proprietor
Phone
(616) 929-4026

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193400000X SINGLE SPECIALTY GROUP 133V00000X 723477 MI Primary

Addresses

Primary practice location

1550 Giddings Ave SE
Grand Rapids, MI 49507

Mailing address

1550 Giddings Ave SE
Grand Rapids, MI 49507-2223
Phone (616) 929-4026

Other names 2

  • Nutrition to Go Other name
  • TracyBooth Other name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1181520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529366400000",
    "number": "1902009475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1550 GIDDINGS AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495072223",
            "telephone_number": "616-929-4026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 GIDDINGS AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49507",
            "telephone_number": "616-560-5696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE STYLES NUTRITION SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-11",
        "last_updated": "2018-06-19",
        "status": "A",
        "authorized_official_last_name": "BOOTH",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "INDEPENDENT CONTRACTOR & PROPRIETOR",
        "authorized_official_telephone_number": "616-929-4026",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "R.D.N"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": "MI",
            "license": "723477",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nutrition to Go",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Nutrition to Go",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "TracyBooth",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2018; 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.