Kelsey Lorraine Bernier, MS, RD, LD, LMT
Individual provider Active NPI Registered Dietitian · Boise, ID
NPI 1790080893 · NPPES record last updated Feb 21, 2023
Key facts
- NPI
- 1790080893
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- D-1022 (ID)
- Practice address
- 305 E Jefferson St
Boise, ID 83712-6231 - Phone
- (208) 381-7340
- NPI assigned
- Jan 20, 2011
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Registered Dietitian Or Nutrition Professional
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- St Lukes Clinic-Treasure Valley LLC
Practice addresses (Care Compare)
520 S Eagle Rd
Meridian, ID 83642-6355
608 W Hays St
Boise, ID 83702-5511
Phone (208) 381-5970
610 W Hays St
Boise, ID 83702-5511
Phone (208) 381-5970
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230313000135 | ID | Practitioner - Registered Dietitian Or Nutrition Professional | 6103290291 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D-1022 | ID | MD | Registered Dietitian |
| MAS-403 | ID | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Lukes Clinic-Treasure Valley LLC | Current |
Accepting new patients | |
| St Lukes Clinic-Treasure Valley LLC | Current |
Accepting new patients | |
| Idaho Nutrition and Wellness Clinic | Dietitian, Registered | Current |
Accepting new patients |
Locations
894 E Boise Ave
Boise, ID 83706
Phone (208) 789-9664
190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378
305 E Jefferson St
Boise, ID 83712
Phone (208) 345-0715
610 W Hays St
Boise, ID 83702
Phone (208) 345-3530
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MAS-403 | ID | |
| Registered Dietitian | 133V00000X | D-1022 | ID | Yes |
Addresses
Primary practice location
305 E Jefferson St
Boise, ID 83712-6231
Mailing address
190 E Bannock St
Boise, ID 83712-6241
Other practice location 1
894 E Boise Ave
Boise, ID 83706-5122
Phone (208) 813-6015
Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 21, 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.