Active NPI
Carly Ruth Metcalf, RD, LD
- Registered Dietitian
- Boise, ID
National Provider Identifier
1790343127
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- D-1129
- Practice address
- 3562 S TK Ave
Boise, ID 83705-5278 - Phone
- (907) 854-0612
- NPI assigned
- May 31, 2019
- 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 | D-1129 | ID | Primary |
Addresses
Primary practice location
3562 S TK Ave
Boise, ID 83705-5278
Mailing address
445 E 50TH St Apt D304
Garden City, ID 83714-1425
Phone (907) 854-0612
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D-1129 | ID | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1559260800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1559260800000",
"number": "1790343127",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "445 E 50TH ST APT D304",
"city": "GARDEN CITY",
"state": "ID",
"postal_code": "837141425",
"telephone_number": "907-854-0612"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3562 S TK AVE",
"city": "BOISE",
"state": "ID",
"postal_code": "837055278",
"telephone_number": "907-854-0612"
}
],
"practiceLocations": [],
"basic": {
"last_name": "METCALF",
"first_name": "CARLY",
"middle_name": "RUTH",
"credential": "RD, LD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-05-31",
"last_updated": "2019-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "ID",
"license": "D-1129",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 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.