Prairie View Creations LLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Legal business name

PRAIRIE VIEW CREATIONS LLC

Practice address

8508 N Prairie VW
Prescott Valley, AZ 86315-9089

Phone

(928) 772-8652

Fax

(928) 772-8078

NPI assigned

Feb 27, 2019

Organization subpart

No

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

Authorized official

Name

Chad Hetherwick, MS, RDNPI 1104023969

Title

Registered Dietitian Nutritionist

Phone

(928) 772-8652

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• Healthy Transitions For Life Doing business as

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Chad Hetherwick, MS, RDN

  • Registered Dietitian
  • Prescott Valley, AZ
  • NPI 1104023969

  Dietitian, Registered

  Medicare reassignment Care Compare group NPD Authorized official
• Kristin Lewis, R.D.

  • Renal Nutrition Registered Dietitian
  • Prescott Valley, AZ
  • NPI 1447574173

  Dietitian, Registered

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1551225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604361600000",
    "number": "1063979961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10214",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863040214",
            "telephone_number": "928-772-8652",
            "fax_number": "928-772-8078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8508 N PRAIRIE VW",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863159089",
            "telephone_number": "928-772-8652",
            "fax_number": "928-772-8078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE VIEW CREATIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-27",
        "last_updated": "2020-11-03",
        "certification_date": "2020-11-03",
        "status": "A",
        "authorized_official_last_name": "HETHERWICK",
        "authorized_official_first_name": "CHAD",
        "authorized_official_title_or_position": "REGISTERED DIETITIAN NUTRITIONIST",
        "authorized_official_telephone_number": "928-772-8652",
        "authorized_official_credential": "MS, RD"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "133VN1004X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered, Nutrition, Pediatric",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133VN1005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered, Nutrition, Renal",
            "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "488506",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Healthy Transitions For Life",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Karyn Anne Poole, MSN, RN, PHN
• Lauren Kathleen Postula, RN
• Jami Potter, FNP
• Hayden Verl Poulson, DPM
• Anna Dusteen Powers, SLP-A
• Beatrice H Preciado, OTRL
• Premier Foot and Ankle, L.L.C.
• Prescott Mobile Physical Therapy and Wellness LLC
• Prescott Quick Care LLC
• Prescott Valley Accident Chiropractic Inc

• Registered Dietitian in Prescott Valley, AZ
• Providers in Prescott Valley, AZ by specialty
• Registered Dietitian in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.