Brooke Campbell Jeppesen, RD
Individual provider Active NPI Registered Dietitian · Malta, ID
NPI 1821963653 · NPPES record last updated Oct 9, 2025
Key facts
- NPI
- 1821963653
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- 6171981 (ID)
- Practice address
- 2502 S Juniper Rd
Malta, ID 83342-8004 - Phone
- (208) 670-0776
- Fax
- (208) 670-0776
- NPI assigned
- Oct 9, 2025
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6171981 | ID | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bradley Management LLC | Dietitian, Registered | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 6171981 | ID | Yes |
Addresses
Primary practice location
2502 S Juniper Rd
Malta, ID 83342-8004
Mailing address
2502 S Juniper Rd
Malta, ID 83342-8004
Phone (208) 670-0776
Other providers in Malta, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 9, 2025. 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.