Cheryl Lynn Coleman, MA, RD, LD

Individual provider Active NPI Registered Dietitian · Hyde Park, UT

NPI 1679170476 · NPPES record last updated Oct 5, 2020

Key facts

NPI
1679170476
Entity type
Individual (NPI type 1)
Primary specialty
Registered Dietitian 133V00000X
License
117687574901 (UT)
Practice address
3935 N 75 W
Hyde Park, UT 84318-4111
Phone
(435) 359-0720
Fax
(833) 992-1993
NPI assigned
Oct 5, 2020
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
117687574901UTMDRegistered Dietitian

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 117687574901 UT Yes

Addresses

Primary practice location

3935 N 75 W
Hyde Park, UT 84318-4111

Mailing address

288 Kentwood Dr
Alabaster, AL 35007-5222
Phone (205) 948-3846

Other identifiers

IdentifierTypeStateIssuer
1669092169MedicaidUT

Electronic endpoints

TypeEndpointUseAffiliation
Other URL https://clarinet.athenahealth.com/clientportal/Current/dashboard/account/login Direct

Other providers in Hyde Park, UT

All providers in Hyde Park, UT · Registered Dietitian in Utah

Sources for this page

Verify at the official NPI Registry.