Katie Malissa Miedema, MPH, RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

D-1173 Issued in ID

Practice address

3000 E Lucca Dr
Meridian, ID 83642-3083

Phone

(949) 572-9275

NPI assigned

Feb 10, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Katie Malissa McCarthy Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1612915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612915200000",
    "number": "1689266629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1740 E FAIRVIEW AVE # 99",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836425702",
            "telephone_number": "949-572-9275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 E LUCCA DR",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836423083",
            "telephone_number": "949-572-9275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIEDEMA",
        "first_name": "KATIE",
        "middle_name": "MALISSA",
        "credential": "MPH, RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-10",
        "last_updated": "2021-02-10",
        "certification_date": "2021-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "ID",
            "license": "D-1173",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATIE",
            "last_name": "MCCARTHY",
            "middle_name": "MALISSA",
            "credential": "MPH, RD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Casey Michel, DPT
• Tracy D. Mickelsen, CSFA
• Midvalley Healthcare PLLC
• Midvalley Healthcare PLLC
• Midvalley Healthcare PLLC
• William Stephen Mihin, D.C.
• Monika Mikkelsen
• Kurt Mildenstein, M.D.
• Kristina Miles, DO
• Michelle Miles, DNP, APRN-CNP, FNP-C

• 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 Feb 10, 2021; 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.