Healthcare Provider Details

I. General information

NPI: 1982290748
Provider Name (Legal Business Name): YOUR FIT FORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 05/17/2022
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 FILER AVE E
TWIN FALLS ID
83301-4118
US

IV. Provider business mailing address

2844 SUNRAY LOOP
TWIN FALLS ID
83301-6700
US

V. Phone/Fax

Practice location:
  • Phone: 208-536-3975
  • Fax:
Mailing address:
  • Phone: 208-731-3374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: APRIL BRUNS
Title or Position: OWNER, REGISTERED DIETITIAN
Credential: RDN, LD
Phone: 208-731-3374