Active NPI
Stephanie Carlson
- Registered Dietitian
- Post Falls, ID
National Provider Identifier
1669936035
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DI60659113
- Practice address
- 5237 W Citruswood Dr
Post Falls, ID 83854-5198 - Phone
- (208) 819-5974
- NPI assigned
- Jan 29, 2019
- Last updated
- Jan 29, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | D920 | ID | |
| Registered Dietitian | 133V00000X | DI60659113 | WA | Primary |
Addresses
Primary practice location
5237 W Citruswood Dr
Post Falls, ID 83854-5198
Mailing address
5237 W Citruswood Dr
Post Falls, ID 83854-5198
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 |
|---|---|---|---|
| D920 | ID | MD | Registered Dietitian |
| DI60659113 | WA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1548720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548720000000",
"number": "1669936035",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5237 W CITRUSWOOD DR",
"city": "POST FALLS",
"state": "ID",
"postal_code": "838545198"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5237 W CITRUSWOOD DR",
"city": "POST FALLS",
"state": "ID",
"postal_code": "838545198",
"telephone_number": "208-819-5974"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLSON",
"first_name": "STEPHANIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-01-29",
"last_updated": "2019-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "ID",
"license": "D920",
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "WA",
"license": "DI60659113",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Post Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.