Kelly Petersen, RD is a medicare enrolled "Dietitian, Registered" provider in Chubbuck, Idaho. She graduated from medical school in 2012 and has 14 years of diverse experience with area of expertise as Registered Dietitian Or Nutrition Professional. She is a member of the group practice Nourish, Inc. and her current practice location is
841 Mckay St, Chubbuck, Idaho. You can reach out to her office (for appointments etc.) via phone at
(208) 705-5553.
Kelly Petersen is licensed to practice in NU (license number ) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1407637101.
Healthcare Provider's Profile
| Full Name | Kelly Petersen |
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| Gender | Female |
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| Speciality | Registered Dietitian Or Nutrition Professional |
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| Experience | 14 Years |
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| Location | 841 Mckay St, Chubbuck, Idaho |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Kelly Petersen graduated from medical school in 2012
NPI Data:
- NPI Number: 1407637101
- Provider Enumeration Date: 10/09/2023
- Last Update Date: 10/09/2023
Medicare PECOS Information:
- PECOS PAC ID: 5092166330
- Enrollment ID: I20240110004526
Medical Identifiers
Medical identifiers for Kelly Petersen such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1407637101 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 133V00000X | Dietitian, Registered | (NU) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Nourish, Inc. | 1557724937 | 288 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Kelly Petersen allows following entities to bill medicare on her behalf.
| Provider Name | Nourish, Inc. |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1558097824
PECOS PAC ID: 1557724937
Enrollment ID: O20230901000471 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kelly Petersen is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Kelly Petersen, RD
3724 Jefferson St Ste 104,
Austin, TX 78731-6204
Ph: Not Available | Kelly Petersen, RD
841 Mckay St,
Chubbuck, ID 83202-4961
Ph: (208) 705-5553 |
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