Active NPI
Heather Dawn Liddell, RDN, LD
- Registered Dietitian
- Boise, ID
National Provider Identifier
1477240935
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- D-1362
- Practice address
- 13900 W Wainwright Dr Ste 102
Boise, ID 83713-5028 - Phone
- (208) 433-9424
- NPI assigned
- Apr 24, 2023
- 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 | D-1362 | ID | Primary |
Addresses
Primary practice location
13900 W Wainwright Dr Ste 102
Boise, ID 83713-5028
Mailing address
5689 W Montage CT
Eagle, ID 83616-7438
Phone (206) 954-4464
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 22, 2026 through Apr 22, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D-1362 | ID | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Idaho Nutrition Associates, LLC | 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": "1682294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1682294400000",
"number": "1477240935",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5689 W MONTAGE CT",
"city": "EAGLE",
"state": "ID",
"postal_code": "836167438",
"telephone_number": "206-954-4464"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13900 W WAINWRIGHT DR STE 102",
"city": "BOISE",
"state": "ID",
"postal_code": "837135028",
"telephone_number": "208-433-9424"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIDDELL",
"first_name": "HEATHER",
"middle_name": "DAWN",
"credential": "RDN, LD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-04-24",
"last_updated": "2023-04-24",
"certification_date": "2023-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "ID",
"license": "D-1362",
"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 Apr 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.