Tailored Nutrition LLC

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

License

81 Issued in WY

Legal business name

TAILORED NUTRITION LLC

Practice address

37 S Main St
Sheridan, WY 82801-4221

Phone

(307) 752-8213

Fax

(307) 675-1866

NPI assigned

Feb 24, 2014

Last updated

Sep 11, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Georgia Fletcher Boley, MS,RD,LD,CSONPI 1922432277

Title

Registered Dietitian

Phone

(307) 752-8213

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Georgia Fletcher Boley, MS,RD,LD,CSO

  • Registered Dietitian
  • Sheridan, WY
  • NPI 1922432277
  Authorized official Same address or phone

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

{
    "created_epoch": "1393200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410393600000",
    "number": "1740605088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37 S MAIN ST",
            "city": "SHERIDAN",
            "state": "WY",
            "postal_code": "828014221",
            "telephone_number": "307-752-8213",
            "fax_number": "307-675-1866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37 S MAIN ST",
            "city": "SHERIDAN",
            "state": "WY",
            "postal_code": "828014221",
            "telephone_number": "307-752-8213",
            "fax_number": "307-675-1866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAILORED NUTRITION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-24",
        "last_updated": "2014-09-11",
        "status": "A",
        "authorized_official_last_name": "BOLEY",
        "authorized_official_first_name": "GEORGIA",
        "authorized_official_middle_name": "FLETCHER",
        "authorized_official_title_or_position": "REGISTERED DIETITIAN",
        "authorized_official_telephone_number": "307-752-8213",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MS,RD,LD,CSO"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "WY",
            "license": "81",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Health Service Clinic/Center in Sheridan, WY
• Providers in Sheridan, WY by specialty
• Health Service Clinic/Center in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2014; 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.