Organization
MINDFUL FORK NUTRITION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE AYOUB RDN, LD (OWNER)
(512) 980-0590
Entity
Organization
Contact information
Practice address
4301 BURNET RD STE A, AUSTIN, TX 78756-3317
(512) 980-0590
(512) 598-5306
Mailing address
1602 EDGEWOOD AVE, AUSTIN, TX 78722-1935
(512) 980-0590
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
—
—
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
06/25/2020
Last updated
06/27/2020
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