Kody Michael Duclos, RD, LD

Primary specialty

Pediatric Nutrition Registered DietitianTaxonomy code 133VN1004X

License

86117056 Issued in ID

Practice address

305 E Jefferson St
Boise, ID 83712-6231

Phone

(208) 381-7081

NPI assigned

Apr 2, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1585785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585785600000",
    "number": "1033748124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5176 W MERCURY CT",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837053746",
            "telephone_number": "208-507-5656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 E JEFFERSON ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126231",
            "telephone_number": "208-381-7081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUCLOS",
        "first_name": "KODY",
        "middle_name": "MICHAEL",
        "credential": "RD, LD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-02",
        "last_updated": "2020-04-02",
        "certification_date": "2020-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133VN1301X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Oncology",
            "state": "ID",
            "license": "86117056",
            "primary": false
        },
        {
            "code": "133VN1401X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Pediatric Critical Care",
            "state": "ID",
            "license": "86117056",
            "primary": false
        },
        {
            "code": "133VN1004X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Pediatric",
            "state": "ID",
            "license": "86117056",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMISSION ON DIETETIC REGISTRATION",
            "identifier": "86117056",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• DTG II PLLC
• Matthew Saul Dubman, APRN-CNP
• Kittrick Randall Duboise, CRNA
• Richard Alan Dubose, MD
• Felica Jo Duce, LCPC
• Casey Dudek
• John Kenneth Dudek, M.D.
• Dudley Chiropractic P.a.
• Chase Dudley, DC
• Timothy Dahl Dudley, D.C.

• Pediatric Nutrition Registered Dietitian in Boise, ID
• Providers in Boise, ID by specialty
• Pediatric Nutrition Registered Dietitian in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 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.