Active NPI
Kywnynn Madsen
- Registered Dietitian
- Blackfoot, ID
National Provider Identifier
1770111924
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86039670
- Practice address
- 98 Poplar St
Blackfoot, ID 83221-1758 - Phone
- (208) 785-4100
- NPI assigned
- Mar 31, 2020
- Last updated
- Mar 31, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 86039670 | ID | Primary |
Addresses
Primary practice location
98 Poplar St
Blackfoot, ID 83221-1758
Mailing address
PO Box 76
Rigby, ID 83442-0076
Phone (208) 589-3054
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86039670 | ID | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Teton Valley Health Care Inc | Past | Accepting new patients | |
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Family Medicine Physician
- Driggs, ID
- NPI 1316294531
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585612800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1585612800000",
"number": "1770111924",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 76",
"city": "RIGBY",
"state": "ID",
"postal_code": "834420076",
"telephone_number": "208-589-3054"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "98 POPLAR ST",
"city": "BLACKFOOT",
"state": "ID",
"postal_code": "832211758",
"telephone_number": "208-785-4100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MADSEN",
"first_name": "KYWNYNN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-03-31",
"last_updated": "2020-03-31",
"certification_date": "2020-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "ID",
"license": "86039670",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Blackfoot, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.