Georgia Fletcher Boley, MS,RD,LD,CSO

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

084 Issued in WY

Practice address

211 Smith St
Sheridan, WY 82801-3818

Phone

(307) 752-8213

Fax

(307) 675-1866

NPI assigned

Aug 22, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WY

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Senior Citizens Council

  • Home Health Agency
  • Sheridan, WY
  • NPI 1265793624
  NPD (past)

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

{
    "created_epoch": "1377129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621555200000",
    "number": "1922432277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "66 BOX CROSS RD",
            "city": "SHERIDAN",
            "state": "WY",
            "postal_code": "828019020",
            "telephone_number": "307-752-8213",
            "fax_number": "307-675-1866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 SMITH ST",
            "city": "SHERIDAN",
            "state": "WY",
            "postal_code": "828013818",
            "telephone_number": "307-752-8213",
            "fax_number": "307-675-1866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLEY",
        "first_name": "GEORGIA",
        "middle_name": "FLETCHER",
        "name_prefix": "Mrs.",
        "credential": "MS,RD,LD,CSO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-08-22",
        "last_updated": "2021-05-21",
        "certification_date": "2021-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MT",
            "license": "87227",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "WY",
            "license": "084",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "156924",
            "state": "WY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.tailorednutritionllc.com",
            "affiliation": "N",
            "endpointDescription": "Website",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "list of services and contact information",
            "address_1": "66 Box Cross Rd",
            "city": "Sheridan",
            "state": "WY",
            "country_code": "US",
            "postal_code": "828019020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Blue Sky Wellness LLC
• Cheyloh Bluemel, FNP-C
• Sarah Bockman, PHARMD
• Body and Soul Wellness LLC
• Charlotte Bohren, M.S. LPC
• Chelsea Bollinger, FNP
• Karlie Boomgarden, COTA
• Donald Edwin Boone, M.S.
• Grant Griffin Boostrom, PHD
• Tara Bower, PTA

• All providers in Sheridan, WY
• Registered Dietitian in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.