Idaho Nutrition and Wellness Clinic

Primary specialty

Registered DietitianTaxonomy code 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

Last updated

Dec 16, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Kelsey L Bernier, MS, RD, LD, LMTNPI 1790080893

Title

Owner, Registered Dietitian

Phone

(208) 789-9664

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, and the practitioner matching its NPPES authorized official.

• Kelsey Lorraine Bernier, MS, RD, LD, LMT

  • Registered Dietitian
  • Boise, ID
  • NPI 1790080893

  Dietitian, Registered

  NPD Authorized official

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

{
    "created_epoch": "1520380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576454400000",
    "number": "1790287563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "894 E BOISE AVE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837065122",
            "telephone_number": "208-813-6015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "894 E BOISE AVE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837065122",
            "telephone_number": "208-789-9664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO NUTRITION AND WELLNESS CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-07",
        "last_updated": "2019-12-16",
        "certification_date": "2019-12-16",
        "status": "A",
        "authorized_official_last_name": "BERNIER",
        "authorized_official_first_name": "KELSEY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER, REGISTERED DIETITIAN",
        "authorized_official_telephone_number": "208-789-9664",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MS, RD, LD, LMT"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Registered Dietitian in Boise, ID
• Providers in Boise, ID by specialty
• Registered Dietitian in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2019; 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.