Active NPI
Lacie Marie Peterson, RD, CD, CDE
- Registered Dietitian
- Salt Lake City, UT
National Provider Identifier
1316052780
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 6120423-4901
- Practice address
- 615 Arapeen Dr
Salt Lake City, UT 84108-1267 - Phone
- (801) 587-3961
- Fax
- (801) 585-5906
- NPI assigned
- Aug 19, 2006
- Last updated
- Nov 9, 2010
- 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 | 6120423-4901 | UT | Primary |
Addresses
Primary practice location
615 Arapeen Dr
Salt Lake City, UT 84108-1267
Mailing address
2016 Stratford Dr
Salt Lake City, UT 84109-1711
Phone (801) 699-5753
Other names 1
- Lacie Marie Matthews
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6120423-4901 | UT | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Teladoc Health Medical Group, P.a. | Dietitian, Registered | Current | Accepting new patients |
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
Interoperability endpoints
- laciepeterson@tdh.allscriptsdirect.net
Organizations & group practices 2
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.
-
- Family Medicine Physician
- Lewisville, TX
- NPI 1245403567
Dietitian, Registered
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1289260800000",
"number": "1316052780",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2016 STRATFORD DR",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841091711",
"telephone_number": "801-699-5753",
"fax_number": "801-585-5906"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "615 ARAPEEN DR",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841081267",
"telephone_number": "801-587-3961",
"fax_number": "801-585-5906"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "LACIE",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "RD, CD, CDE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-19",
"last_updated": "2010-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "UT",
"license": "6120423-4901",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "LACIE",
"last_name": "MATTHEWS",
"middle_name": "MARIE",
"credential": "RD, CD, CDE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.