Healthcare Provider Details

I. General information

NPI: 1255181780
Provider Name (Legal Business Name): KATIE M HARDY RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATIE GRANT

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S EAGLE RD
MERIDIAN ID
83642-6351
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 208-706-5260
  • Fax: 208-706-5855
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1081701
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: