Provider Demographics
NPI:1457868531
Name:MYERS, RACHEL (RD, LD, CDE)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S EAGLE RD STE 1229
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6355
Mailing Address - Country:US
Mailing Address - Phone:208-884-4220
Mailing Address - Fax:208-383-0190
Practice Address - Street 1:520 S EAGLE RD STE 1229
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6355
Practice Address - Country:US
Practice Address - Phone:208-884-4220
Practice Address - Fax:208-383-0190
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-851133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered