| Stacy Beeson, | |
|
102 W Jefferson St, Boise, ID 83702-6124 | |
| (208) 381-7831 | |
| Not Available |
| Full Name | Stacy Beeson |
|---|---|
| Gender | Female |
| Speciality | Registered Dietitian Or Nutrition Professional |
| Experience | 31 Years |
| Location | 102 W Jefferson St, Boise, Idaho |
| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811310360 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 133V00000X | Dietitian, Registered | 810997 (Colorado) | Primary |
| 133V00000X | Dietitian, Registered | D-360 (Idaho) | Secondary |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Catholic Health Initiatives Colorado | 8022927342 | 972 |
| Provider Name | Catholic Health Initiatives Colorado |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1356783351 PECOS PAC ID: 8022927342 Enrollment ID: O20031215000462 |
| Provider Name | Nutrition Dynamix |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1023565777 PECOS PAC ID: 3870908916 Enrollment ID: O20210223000792 |
| Mailing Address | Practice Location Address |
|---|---|
| Stacy Beeson, 417 Promenade Dr, Superior, CO 80027-8652 Ph: (208) 559-0307 | Stacy Beeson, 102 W Jefferson St, Boise, ID 83702-6124 Ph: (208) 381-7831 |
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