Jennifer Lisa Anthony, RD
Individual provider Active NPI Obesity and Weight Management Nutrition Registered Dietitian · Boise, ID
NPI 1760156152 · NPPES record last updated Dec 15, 2023
Key facts
- NPI
- 1760156152
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Obesity and Weight Management Nutrition Registered Dietitian 133VN1201X
- License
- D-1017 (ID)
- Practice address
- 777 N Raymond St
Boise, ID 83704-9251 - Phone
- (208) 514-2500
- NPI assigned
- Aug 9, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230223001350 | ID | Practitioner - Registered Dietitian Or Nutrition Professional | 2264805167 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D-1017 | ID | MD | Obesity and Weight Management Nutrition Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Full Circle Health, Inc. | Current |
Accepting new patients | |
| Saint Alphonsus Regional Medical Center Inc | Current |
Accepting new patients | |
| Saint Alphonsus Regional Medical Center Inc | Current | Accepting new patients | |
| Saint Alphonsus Regional Medical Center Inc | Current |
Accepting new patients |
Locations
777 N Raymond St
Boise, ID 83704
Phone (208) 367-6030
3025 W Cherry Ln
Ste B
Meridian, ID 83642
Phone (208) 302-6400
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nutrition Registered Dietitian | 133VN1004X | |||
| Obesity and Weight Management Nutrition Registered Dietitian | 133VN1201X | D-1017 | ID | Yes |
Addresses
Primary practice location
777 N Raymond St
Boise, ID 83704-9251
Mailing address
777 N Raymond St
Boise, ID 83704-9251
Phone (208) 514-2500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760156152 | Medicaid | ID |
Other providers in Boise, ID
- Another Chance Counseling, PLLC
- Hina Aijaz Ansari
- Suzanne M Anstine
- Carrie R Anstrand
- Anthony D Keys MD PA
- Julie R Anthony
- Anticipate Greatness, LLC
- Naya N Antink
- Edward A Anton
- Jacquelyne Renee Anton
All providers in Boise, ID · Obesity and Weight Management Nutrition Registered Dietitian in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 15, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.