Active NPI
Staci M Kidder, R.D.
- Registered Dietitian
- Boise, ID
National Provider Identifier
1659612729
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- D-468
- Practice address
- 5418 N Eagle Rd Ste 120
Boise, ID 83713-0103 - Phone
- (208) 939-1500
- Fax
- (208) 939-1510
- NPI assigned
- Mar 13, 2013
- 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-468 | ID | Primary |
Addresses
Primary practice location
5418 N Eagle Rd Ste 120
Boise, ID 83713-0103
Mailing address
5418 N Eagle Rd Ste 120
Boise, ID 83713-0103
Phone (208) 939-1500
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D-468 | ID | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Synergy Chiropractic, PLLC | 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": "1363132800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1363132800000",
"number": "1659612729",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5418 N EAGLE RD STE 120",
"city": "BOISE",
"state": "ID",
"postal_code": "837130103",
"telephone_number": "208-939-1500",
"fax_number": "208-939-1510"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5418 N EAGLE RD STE 120",
"city": "BOISE",
"state": "ID",
"postal_code": "837130103",
"telephone_number": "208-939-1500",
"fax_number": "208-939-1510"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIDDER",
"first_name": "STACI",
"middle_name": "M",
"credential": "R.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-03-13",
"last_updated": "2013-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "ID",
"license": "D-468",
"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 Mar 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.