Trailblazer Integrative & Functional Nutrition, LLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Legal business name

TRAILBLAZER INTEGRATIVE & FUNCTIONAL NUTRITION, LLC

Practice address

2198 W Jayton Dr
Meridian, ID 83642-7600

Phone

(208) 870-3002

Fax

(208) 957-6544

NPI assigned

Nov 23, 2022

Organization subpart

No

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

Authorized official

Name

Hailie Kuttler, RDN, LD, IFNCP

Title

Owner

Phone

(208) 870-3002

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1669161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673308800000",
    "number": "1649989161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2198 W JAYTON DR",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836427600",
            "telephone_number": "208-870-3002",
            "fax_number": "208-957-6544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2198 W JAYTON DR",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836427600",
            "telephone_number": "208-870-3002",
            "fax_number": "208-957-6544"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3673 E Sweet Pea Ct",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837166939",
            "country_code": "US",
            "telephone_number": "208-870-3002",
            "fax_number": "208-957-6544",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TRAILBLAZER INTEGRATIVE & FUNCTIONAL NUTRITION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-23",
        "last_updated": "2023-01-10",
        "certification_date": "2023-01-10",
        "status": "A",
        "authorized_official_last_name": "KUTTLER",
        "authorized_official_first_name": "HAILIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-870-3002",
        "authorized_official_credential": "RDN, LD, IFNCP"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Total Renal Care Inc
• Touchmark at Meadow Lake Village Reitrement Resort, LLC
• Touchmark at Meadow Lake Village, LLC
• Touchmark of the Treasure Valley, LLC
• Ashley Metronus Trace, LCSW
• Trailhead Medical Group LLC
• Transformations Idaho PLLC
• Emily Jeanne Trantham, PA-C
• Treasure Valley Assessments & Counseling LLC
• Treasure Valley Childrens Clinic, PC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2023; 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.