Active NPI
Karen Mangum, M.S., R.D.N., L.D.
- Registered Dietitian
- Boise, ID
National Provider Identifier
1194264077
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- D-208
- Practice address
- 115 N. Main Street
Suite #203
Boise, ID 83702 - Phone
- (208) 381-8330
- NPI assigned
- Feb 13, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | D-208 | ID | Primary |
Addresses
Primary practice location
115 N. Main Street
Suite #203
Boise, ID 83702
Mailing address
4726 W Clear Field Dr
Eagle, ID 83616-6957
Phone (208) 440-5041
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D-208 | ID | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1486944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486944000000",
"number": "1194264077",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4726 W CLEAR FIELD DR",
"city": "EAGLE",
"state": "ID",
"postal_code": "836166957",
"telephone_number": "208-440-5041"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 N. MAIN STREET",
"address_2": "SUITE #203",
"city": "BOISE",
"state": "ID",
"postal_code": "83702",
"telephone_number": "208-381-8330"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANGUM",
"first_name": "KAREN",
"credential": "M.S., R.D.N., L.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-02-13",
"last_updated": "2017-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "ID",
"license": "D-208",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.