Provider Demographics
NPI:1295405967
Name:HERMES, HAILIE KATE (RDN, LD, IFNCP)
Entity type:Individual
Prefix:
First Name:HAILIE
Middle Name:KATE
Last Name:HERMES
Suffix:
Gender:
Credentials:RDN, LD, IFNCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 N AMBERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-7619
Mailing Address - Country:US
Mailing Address - Phone:208-870-3002
Mailing Address - Fax:
Practice Address - Street 1:3901 N AMBERWOOD AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-7619
Practice Address - Country:US
Practice Address - Phone:208-870-3002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-1208133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered