Individual provider Active NPI

Natasha Dawn Bordeaux

  • Registered Dietitian
  • Kayenta, AZ
National Provider Identifier
1639734890
Registry record updated May 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
Practice address
Hwy 160 MP 394.3
Kayenta, AZ 86033
Phone
(928) 697-4000
NPI assigned
May 3, 2019
Last updated
May 3, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 3, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X Primary

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201012001214 TX Practitioner - Registered Dietitian Or Nutrition Professional 6800216920 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
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 BoardGroup PAC ID 0648609917, 64 clinicians

Practice addresses (Care Compare)

3200 Canyon Lake Dr
Rapid City, SD 57702-8114
Phone 60535525002356

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Jicarilla IHS Pharmacy CurrentSince Mar 5, 2023 Accepting new patients
Woodrow Wilson Keeble Memorial Health Care Center CurrentSince Jun 13, 2023 Accepting new patients
Great Plains Tribal Chairmen's Health Board CurrentSince Oct 6, 2025 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

Organizations & group practices 4

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "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

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.