Natasha Dawn Bordeaux
Individual provider Active NPI Registered Dietitian · Kayenta, AZ
NPI 1639734890 · NPPES record last updated May 3, 2019
Key facts
- NPI
- 1639734890
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- Practice address
- Hwy 160 MP 394.3
Kayenta, AZ 86033 - Phone
- (928) 697-4000
- NPI assigned
- May 3, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Registered Dietitian Or Nutrition Professional
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Great Plains Tribal Chairmen'S Health Board
Practice addresses (Care Compare)
3200 Canyon Lake Dr
Rapid City, SD 57702-8114
Phone 60535525002356
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201012001214 | TX | Practitioner - Registered Dietitian Or Nutrition Professional | 6800216920 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Woodrow Wilson Keeble Memorial Health Care Center | Current |
Accepting new patients | |
| Great Plains Tribal Chairmen'S Health Board | Current |
Accepting new patients | |
| Jicarilla IHS Pharmacy | Current |
Accepting new patients |
Locations
3200 Canyon Lake Dr
Rapid City, SD 57702
Phone (605) 355-2282
3200 Canyon Lake Dr
Ste 1
Rapid City, SD 57702
Phone (605) 355-2500
100 Lake Traverse Dr
Sisseton, SD 57262
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | Yes |
Addresses
Primary practice location
Hwy 160 MP 394.3
Kayenta, AZ 86033
Mailing address
PO Box 915
Kayenta, AZ 86033-0915
Phone (928) 697-4210
NPI Registry JSON
{
"created_epoch": "1556841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1556841600000",
"number": "1639734890",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 915",
"city": "KAYENTA",
"state": "AZ",
"postal_code": "860330915",
"telephone_number": "928-697-4210"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "HWY 160 MP 394.3",
"city": "KAYENTA",
"state": "AZ",
"postal_code": "86033",
"telephone_number": "928-697-4000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BORDEAUX",
"first_name": "NATASHA",
"middle_name": "DAWN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-05-03",
"last_updated": "2019-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kayenta, AZ
- Urina Bitsinnie
- Kimora A Bizahaloni
- Zona Black Calf
- Amanda Leeh Blackhorse
- Anna Boone
- Amanda Jo Bradley
- Dan Bradley Jr.
- Donna Ellen Bradley
- Allison Brandum
- Misty Breaux
All providers in Kayenta, AZ · Registered Dietitian in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 3, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.