Northwest Functional Nutrition, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

NORTHWEST FUNCTIONAL NUTRITION, LLC

Practice address

19125 N Creek Pkwy Ste 120
Bothell, WA 98011-8000

Phone

(425) 588-0480

NPI assigned

Jan 14, 2020

Organization subpart

No

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

Authorized official

Name

Nikki Gepner, RD, CDNPI 1902084254

Title

Owner

Phone

(425) 588-0480

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.

• Nikki Gepner, RDN

  • Registered Dietitian
  • Bothell, WA
  • NPI 1902084254
  NPD Authorized official

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

{
    "created_epoch": "1578960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632182400000",
    "number": "1760022156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 821092",
            "city": "KENMORE",
            "state": "WA",
            "postal_code": "980280999",
            "telephone_number": "425-588-0480",
            "fax_number": "833-464-0125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19125 N CREEK PKWY STE 120",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980118000",
            "telephone_number": "425-588-0480"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16818 140th Ave NE",
            "address_purpose": "LOCATION",
            "city": "Woodinville",
            "state": "WA",
            "postal_code": "980729001",
            "country_code": "US",
            "telephone_number": "425-588-0480",
            "fax_number": "833-464-0125",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NORTHWEST FUNCTIONAL NUTRITION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-14",
        "last_updated": "2021-09-21",
        "certification_date": "2021-09-21",
        "status": "A",
        "authorized_official_last_name": "GEPNER",
        "authorized_official_first_name": "NIKKI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "425-588-0480",
        "authorized_official_credential": "RD, CD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Bothell, WA
• Providers in Bothell, WA by specialty
• Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 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.