| Elisabeth Stephens, RD | |
|
805 N 6th E, Mountain Home, ID 83647-2207 | |
| (208) 587-2450 | |
| (208) 587-2451 |
| Full Name | Elisabeth Stephens |
|---|---|
| Gender | Female |
| Speciality | Dietitian, Registered |
| Location | 805 N 6th E, Mountain Home, Idaho |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639876345 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 133V00000X | Dietitian, Registered | D-1463 (Idaho) | Primary |
| 133V00000X | Dietitian, Registered | (Idaho) | Secondary |
| Provider Name | St Lukes Clinic Llc |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1790718229 PECOS PAC ID: 1052217478 Enrollment ID: O20031208000899 |
| Mailing Address | Practice Location Address |
|---|---|
| Elisabeth Stephens, RD 190 E Bannock St, Boise, ID 83712-6241 Ph: () - | Elisabeth Stephens, RD 805 N 6th E, Mountain Home, ID 83647-2207 Ph: (208) 587-2450 |
Austen Davis Kemper, RD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 2280 American Legion Blvd, Mountain Home, ID 83647 Phone: 208-881-1960 | |
Mountain Home Nutrition Services Llc Dietitian Medicare: Not Enrolled in Medicare Practice Location: 285 E 4th N, Mountain Home, ID 83647 Phone: 208-590-0858 | |
Ms. Laura Jean Moulton, R.D.N. Dietitian Medicare: Not Enrolled in Medicare Practice Location: 285 E 4th N, Mountain Home, ID 83647 Phone: 208-590-0858 Fax: 855-740-2997 | |
Jacob Hohenshelt, RDN Dietitian Medicare: Not Enrolled in Medicare Practice Location: 895 N 6th E, Mountain Home, ID 83647 Phone: 208-841-5393 |