Idaho Nutrition and Wellness Clinic
Organization Active NPI Registered Dietitian · Boise, ID
NPI 1790287563 · NPPES record last updated Dec 16, 2019
Key facts
- NPI
- 1790287563
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Registered Dietitian 133V00000X
- Legal business name
- IDAHO NUTRITION AND WELLNESS CLINIC
- Practice address
- 894 E Boise Ave
Boise, ID 83706-5122 - Phone
- (208) 789-9664
- NPI assigned
- Mar 7, 2018
- Organization subpart
- No
Authorized official
- Name
- Mrs. Kelsey L Bernier, MS, RD, LD, LMT
- Title
- Owner, Registered Dietitian
- Phone
- (208) 789-9664
Practitioners 1
-
Kelsey Lorraine Bernier, MS, RD, LD, LMT
National Provider Directory
Locations
894 E Boise Ave
Boise, ID 83706
Phone (208) 789-9664
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian |
133V00000X | Yes |
Addresses
Primary practice location
894 E Boise Ave
Boise, ID 83706-5122
Mailing address
894 E Boise Ave
Boise, ID 83706-5122
Phone (208) 813-6015
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| IDTPID011885 | Medicaid | ID |
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 16, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.