Active NPI
Kaidy Wallace, RDN
- Registered Dietitian
- Manchester, NH
National Provider Identifier
1285346452
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- Practice address
- 12 Ingalls St
Manchester, NH 03102-4644 - Phone
- (401) 743-0906
- NPI assigned
- Dec 20, 2022
- Sex
- Female
- Sole proprietor
- No
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 | Primary |
Addresses
Primary practice location
12 Ingalls St
Manchester, NH 03102-4644
Mailing address
12 Ingalls St
Manchester, NH 03102-4644
Phone (401) 743-0906
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)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1671494400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1755043200000",
"number": "1285346452",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12 INGALLS ST",
"city": "MANCHESTER",
"state": "NH",
"postal_code": "031024644",
"telephone_number": "401-743-0906"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12 INGALLS ST",
"city": "MANCHESTER",
"state": "NH",
"postal_code": "031024644",
"telephone_number": "401-743-0906"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "KAIDY",
"credential": "RDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-12-20",
"last_updated": "2025-08-13",
"certification_date": "2025-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manchester, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.