NPI 1124569959 · live from the CMS NPI Registry
Simply Dietetics, LLC
Dietitian, Registered in Sheridan, WY. National Provider Identifier 1124569959, active.
NPI record
| NPI | 1124569959 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Dietitian, Registered 133V00000X |
| Practice location | 172 N Main St, Suite 1a, Sheridan, WY 82801 |
| Practice phone | 208-866-2568 |
| Mailing address | Po Box 542, Dayton, WY 82836 |
| Enumerated | March 13, 2017 |
| Last updated | March 13, 2017 |
| Authorized official | Jordan Mccoy, Owner Registered Dietitian |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dietitian, Registered, Nutrition, Pediatric | 133VN1004X | — |
| Dietitian, Registered primary | 133V00000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.