Healthcare Provider Details

I. General information

NPI: 1760629893
Provider Name (Legal Business Name): BLAIRE SNELL PICKERING RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2009
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1424 E FOREMASTER DR STE 140
ST GEORGE UT
84790-5830
US

IV. Provider business mailing address

700 NORTH SPRING STREET P.O. BOX 1010
CALIENTE NV
89008-1010
US

V. Phone/Fax

Practice location:
  • Phone: 435-251-2888
  • Fax:
Mailing address:
  • Phone: 775-726-3171
  • Fax: 775-726-3797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number997076
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: