Sheridan Peak Wellness

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

232 Issued in WY

Legal business name

SHERIDAN PEAK WELLNESS

Practice address

740 S. Thurmond St.
Sheridan, WY 82801

Phone

(307) 683-6874

Fax

(415) 559-4790

NPI assigned

Jun 20, 2018

Organization subpart

No

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

Authorized official

Name

Miss Jennifer Lee Clark, R.D.

Title

Corporation Owner

Phone

(307) 683-6874

Specialties & licenses 4

Addresses

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

{
    "created_epoch": "1529452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529452800000",
    "number": "1053805382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "740 S. THURMOND ST.",
            "city": "SHERIDAN",
            "state": "WY",
            "postal_code": "82801",
            "telephone_number": "307-683-6874",
            "fax_number": "415-559-4790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "740 S. THURMOND ST.",
            "city": "SHERIDAN",
            "state": "WY",
            "postal_code": "82801",
            "telephone_number": "307-683-6874",
            "fax_number": "415-559-4790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHERIDAN PEAK WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-20",
        "last_updated": "2018-06-20",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "CORPORATION OWNER",
        "authorized_official_telephone_number": "307-683-6874",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "R.D."
    },
    "taxonomies": [
        {
            "code": "133NN1002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nutritionist, Nutrition, Education",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": "WY",
            "license": "232",
            "primary": true
        },
        {
            "code": "133VN1004X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered, Nutrition, Pediatric",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133VN1006X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Registered Dietitian in Sheridan, WY
• Providers in Sheridan, WY by specialty
• Registered Dietitian in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 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.