Macey Renae Leatham, RDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

86096533 Issued in ID

Practice address

1298 Idaho Ave Apt 1
Idaho Falls, ID 83402-1247

Phone

(208) 716-0244

NPI assigned

Feb 2, 2021

Last updated

Feb 2, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1612224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612224000000",
    "number": "1043801087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1298 IDAHO AVE APT 1",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834021247",
            "telephone_number": "208-716-0244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1298 IDAHO AVE APT 1",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834021247",
            "telephone_number": "208-716-0244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEATHAM",
        "first_name": "MACEY",
        "middle_name": "RENAE",
        "credential": "RDN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-02-02",
        "last_updated": "2021-02-02",
        "certification_date": "2021-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "ID",
            "license": "86096533",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• LDS Family Services
• Matthew Carter Leal, RBT
• Lean on Me Agency
• Lean on Me, Inc.
• Katie Jo Leask, RD, LD, IBCLC
• Leavitt Womens Healthcare Corp,P.C.
• Glenn Ralph Leavitt, DO
• Wade Darren Leavitt, LMSW
• Wende Christine Leavitt, PA-C
• Jennifer Lebel, R.N.

• Registered Dietitian in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Registered Dietitian in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2021; 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.