Healthcare Provider Details

I. General information

NPI: 1841905270
Provider Name (Legal Business Name): LYNNETTE TRICIA ANN BARKER MS, RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2023
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3910 WASHINGTON PKWY
IDAHO FALLS ID
83404-7883
US

IV. Provider business mailing address

8125 N NEVA RD
POCATELLO ID
83204-7003
US

V. Phone/Fax

Practice location:
  • Phone: 208-523-1122
  • Fax: 208-523-2582
Mailing address:
  • Phone: 208-589-2421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1031468
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: