NPI 1033748124 · live from the CMS NPI Registry
Kody Michael Duclos, RD, LD
Dietitian, Registered, Nutrition, Pediatric in Boise, ID. National Provider Identifier 1033748124, active.
NPI record
| NPI | 1033748124 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dietitian, Registered, Nutrition, Pediatric 133VN1004X |
| Practice location | 305 E Jefferson St, Boise, ID 83712 |
| Practice phone | 208-381-7081 |
| Mailing address | 5176 W Mercury Ct, Boise, ID 83705 |
| Enumerated | April 2, 2020 |
| Last updated | April 2, 2020 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dietitian, Registered, Nutrition, Oncology | 133VN1301X | 86117056 (ID) |
| Dietitian, Registered, Nutrition, Pediatric Critical Care | 133VN1401X | 86117056 (ID) |
| Dietitian, Registered, Nutrition, Pediatric primary | 133VN1004X | 86117056 (ID) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.