Active NPI
Luke Raymond Bolt, MS, RDN, ACSM EP-C
- Registered Dietitian
- Lakewood, WA
National Provider Identifier
1427904648
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- Practice address
- 12515 Gravelly Lake Dr SW
Lakewood, WA 98499-1423 - Phone
- (253) 495-8191
- NPI assigned
- Mar 9, 2026
- Sex
- Male
- 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 | WA | Primary |
Addresses
Primary practice location
12515 Gravelly Lake Dr SW
Lakewood, WA 98499-1423
Mailing address
12515 Gravelly Lake Dr SW
Lakewood, WA 98499-1423
Phone (253) 495-8191
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
- Credentials
- Master of Science
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1773014400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1773014400000",
"number": "1427904648",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12515 GRAVELLY LAKE DR SW",
"city": "LAKEWOOD",
"state": "WA",
"postal_code": "984991423",
"telephone_number": "253-495-8191"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12515 GRAVELLY LAKE DR SW",
"city": "LAKEWOOD",
"state": "WA",
"postal_code": "984991423",
"telephone_number": "253-495-8191"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLT",
"first_name": "LUKE",
"middle_name": "RAYMOND",
"credential": "MS, RDN, ACSM EP-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2026-03-09",
"last_updated": "2026-03-09",
"certification_date": "2026-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "WA",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lakewood, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.