Active NPI
Debra Ann Boutin, MS, RD, CD
- Registered Dietitian
- Kenmore, WA
National Provider Identifier
1669511358
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DI00000803
- Practice address
- 14500 Juanita Dr NE
Kenmore, WA 98028-4966 - Phone
- (425) 602-3124
- Fax
- (425) 823-6222
- NPI assigned
- Feb 6, 2007
- Last updated
- Jul 8, 2007
- 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 | DI00000803 | WA | Primary |
Addresses
Primary practice location
14500 Juanita Dr NE
Kenmore, WA 98028-4966
Mailing address
14500 Juanita Dr NE
Kenmore, WA 98028-4966
Phone (425) 602-3124
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DI00000803 | WA | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Becoming Mama | Past | Accepting new patients | |
| Bastyr University | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Student in an Organized Health Care Education/Training Program
- Atlanta, GA
- NPI 1386230803
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1669511358",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14500 JUANITA DR NE",
"city": "KENMORE",
"state": "WA",
"postal_code": "980284966",
"telephone_number": "425-602-3124",
"fax_number": "425-823-6222"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14500 JUANITA DR NE",
"city": "KENMORE",
"state": "WA",
"postal_code": "980284966",
"telephone_number": "425-602-3124",
"fax_number": "425-823-6222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUTIN",
"first_name": "DEBRA",
"middle_name": "ANN",
"credential": "MS, RD, CD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "WA",
"license": "DI00000803",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kenmore, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.