Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
NPIDirectory

Kelly Petersen, RD

Individual provider Registered Dietitian · NPI 1407637101

Kelly Petersen, RD is registered under 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 →

Claim this listing Report a problem Suggest an edit

Practice location Address checks out

841 McKay St
Chubbuck, ID 83202-4961
Phone: (208) 705-5553
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

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

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

Colleagues at Nourish, Inc

Clinicians the CMS Doctors & Clinicians file lists under the same group practice. CMS counts 277 clinicians in the practice; 12 are shown here.

Other providers in Chubbuck