Etosha Farmer, MS, RDN, CDCES

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Practice address

415 Sherman St
Watertown, NY 13601-3920

Phone

(312) 221-4881

Fax

(315) 777-4111

NPI assigned

Jul 20, 2011

Last updated

Nov 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Specialty

Registered Dietitian Or Nutrition Professional

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dietitians of Northern New York PLLCGroup PAC ID 8022497981, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dietitians of Northern New York, PLLC.

  dba Dietitians of Northern New York

  • Registered Dietitian
  • Watertown, NY
  • NPI 1316515208

  Dietitian, Registered

  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1311120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668988800000",
    "number": "1144518499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 SHERMAN ST",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136013920",
            "telephone_number": "315-221-4881",
            "fax_number": "315-777-4111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 SHERMAN ST",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136013920",
            "telephone_number": "312-221-4881",
            "fax_number": "315-777-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FARMER",
        "first_name": "ETOSHA",
        "credential": "MS, RDN, CDCES",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-20",
        "last_updated": "2022-11-21",
        "certification_date": "2022-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kyra Fairley
• Spencer Falcon, M.D.
• Family Chiropractic Care, PC
• Family Counseling Service of Nny, Inc.
• Family Counseling Service of Nny, Inc.
• Vicci Louise Farney, OTR
• Samantha Farone
• Farook J Kidwai MD PC
• Francis Joseph Farrell, M.D.
• Andrea Mary Favret, RPH

• Registered Dietitian in Watertown, NY
• Providers in Watertown, NY by specialty
• Registered Dietitian in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.