NPI 1811310360 · live from the CMS NPI Registry
Stacy Beeson
Dietitian, Registered in Nampa, ID. National Provider Identifier 1811310360, active.
NPI record
| NPI | 1811310360 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dietitian, Registered 133V00000X |
| Practice location | 9850 W St Lukes Dr Ste 327, Nampa, ID 83687 |
| Practice phone | 208-331-1155 |
| Mailing address | 190 E Bannock St, Boise, ID 83712 |
| Enumerated | February 3, 2014 |
| Last updated | October 28, 2025 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dietitian, Registered | 133V00000X | 810997 (CO) |
| Dietitian, Registered primary | 133V00000X | 1071188 (ID) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.