Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Kelly Petersen, RD

Individual provider Registered Dietitian · NPI 1407637101

Kelly Petersen, RD is a Registered Dietitian OR Nutrition Professional in Chubbuck, Idaho. Qualified in 2012, 14 years ago. Practices with Nourish, Inc, a 277-clinician group and accepts Medicare assignment.

Years since qualifying
14
In the registry since
2023
What do these letters mean?
RD — Registered Dietitian
A credentialed nutrition professional.

See every abbreviation used in this directory →

Practice location Address checks out

841 McKay St
Chubbuck, ID 83202-4961
Phone: (208) 705-5553
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Registered Dietitian (primary) Taxonomy 133V00000X

Record details

NPI number1407637101
Entity typeIndividual (Type 1)
GenderFemale
Credentials RD
Sole proprietorNo
NPI enumeratedOctober 9, 2023
Last updated in NPPESOctober 9, 2023
Certification dateOctober 9, 2023
Mailing address3724 Jefferson St Ste 104, Austin, TX 78731-6204

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyREGISTERED DIETITIAN OR NUTRITION PROFESSIONAL
Medical schoolOTHER
Graduated 2012 (14 years in practice)
Group practice Nourish, Inc. — 277 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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