Alexandria Nicole Peterson, RDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

D-1212 Issued in ID

Practice address

407 S Florence Ave
Sandpoint, ID 83864-1784

Phone

(208) 610-7610

NPI assigned

Dec 7, 2020

Last updated

Dec 12, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1607299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607731200000",
    "number": "1649876459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 S FLORENCE AVE",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838641784",
            "telephone_number": "208-610-7610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 S FLORENCE AVE",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838641784",
            "telephone_number": "208-610-7610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "ALEXANDRIA",
        "middle_name": "NICOLE",
        "credential": "RDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-07",
        "last_updated": "2020-12-12",
        "certification_date": "2020-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "ID",
            "license": "D-1212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://my.practicebetter.io/#/p/forms/5faf276f2a832611c8aa0ca0/edit",
            "affiliation": "N",
            "endpointDescription": "HIPAA  compliant health practitioner software",
            "address_1": "407 S Florence Ave",
            "city": "Sandpoint",
            "state": "ID",
            "country_code": "US",
            "postal_code": "838641784",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Shannon Marie Perkins Baker, LMSW
• Barbara Perusse, LCPC
• Catherine Perusse, LPC
• Brayden Petersen, OD
• Jason Petersen, O.D.
• Suzanne Peyser
• Erin Phillips, LMT
• Jordyn Leeann Phillips, OTR/L
• Pinnacle Health Center, Inc.
• Pinnacle Performance Inc

• Registered Dietitian in Sandpoint, ID
• Providers in Sandpoint, ID by specialty
• Registered Dietitian in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.