Organization
NUTRITION SOLUTIONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLILYN WORLEY MS, RDN, LD (OWNER)
(409) 454-0417
Entity
Organization
Contact information
Practice address
990 INTERSTATE 10 N, SUITE 215, BEAUMONT, TX 77702-1051
(409) 454-0417
(888) 977-1202
Mailing address
990 INTERSTATE 10 N, SUITE 215, BEAUMONT, TX 77702-1051
(888) 977-1202
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT06620
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3173858
—
TX
01
—
402025
MEDICARE PTAN
TX
Enumeration date
04/20/2016
Last updated
04/20/2016
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