Kelli Frederick, RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

DI00001335 Issued in WA

Practice address

11703 E Sprague Ave
BLDG C-3
Spokane Valley, WA 99206-6128

Phone

(509) 921-6560

NPI assigned

May 28, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

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": "1211932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211932800000",
    "number": "1174781967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 W WOODWAY AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992182663",
            "telephone_number": "509-921-6560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11703 E SPRAGUE AVE",
            "address_2": "BLDG C-3",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992066128",
            "telephone_number": "509-921-6560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICK",
        "first_name": "KELLI",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-28",
        "last_updated": "2008-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "WA",
            "license": "DI00001335",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9051731",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA CERTIFICATION NUMBER",
            "identifier": "DI00001335",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NUMBER",
            "identifier": "8293979",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADA NUMBER",
            "identifier": "887397",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kyle Frazier, PHARMD
• Jessica Gail Freas, MS, LMHC, MHP, CMHS
• Fred Meyer Stores Inc
• Annie Frederick, RDT
• Kathleen Elizabeth Frederick, L.M.P.
• Megan Frederick
• Selah F Fredericks, LMT
• Freedom Consulting, LLC
• Freedom Health & Financial Services LLC
• Freedomcare of Wa, LLC

• Registered Dietitian in Spokane Valley, WA
• Providers in Spokane Valley, WA by specialty
• Registered Dietitian in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2008; 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.