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Organization
SIMPLY DIETETICS, LLC
Active
Organization
SIMPLY DIETETICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JORDAN PAIGE MCCOY MS RD LD (OWNER REGISTERED DIETITIAN)
(208) 866-2568
Entity
Organization
Contact information
Practice address
172 N MAIN ST, SUITE 1A, SHERIDAN, WY 82801-3921
(208) 866-2568
Mailing address
PO BOX 542, DAYTON, WY 82836-0542
(208) 866-2568
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
133VN1004X
Pediatric Nutrition Registered Dietitian
—
—
Other
Enumeration date
03/13/2017
Last updated
03/13/2017
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