STEPHANIE KIM ANNILLO


Address: 1055 N 500 W Ste 205, Provo, UT 84604-3305
Phone: 8014298095

STEPHANIE KIM ANNILLO (NPI# 1659785640) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1659785640
Entity Type Individual
Full Name STEPHANIE KIM ANNILLO
Credential RD, CDE
Practice Address 1055 N 500 W Ste 205
Provo
UT 84604-3305
Mailing Address 1055 N 500 W
Attn Credentialing
Provo
UT 84604-3305
Practice Telephone 8014298095
Practice Fax Number 8013548265
Mailing Telephone 8013548225
Mailing Fax Number 8014180941
Enumeration Date 2014-06-17
Last Update Date 2020-03-19
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 133V00000X Dietitian, Registered 1114008-4901 UT Dietary & Nutritional Service Providers
N 133V00000X Dietitian, Registered 35596DI-0 NV Dietary & Nutritional Service Providers

Provider Secondary Practice Location

Address Telephone Number Fax Number
1175 E 50 S Ste 241, American Fork, UT 840032849 8014298008 8014180928

Office Location

Street Address 1055 N 500 W STE 205
City PROVO
State UT
Zip Code 84604-3305

Providers in the same location

NPI Name Taxonomy Address Enumeration
1326203514 Mohammed Soubhi Nizam Internal Medicine 1055 N 500 W Ste 205, Provo, UT 84604-3305 2008-07-28
1770124687 Kevin Johnson Nurse Practitioner 1055 N 500 W Ste 205, Provo, UT 84604-3305 2019-10-02
1922550060 Leslie Diane Putnam Nurse Practitioner 1055 N 500 W Ste 205, Provo, UT 84604-3305 2016-10-25

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1346882107 Abigail Belle Hardy Student in an Organized Health Care Education/Training Program 1190 900 E, Provo, UT 84604 2019-10-14
1386106698 Sarah Roseman Hunt Nurse Practitioner 1055 N 500 W., Suite. 101, Bldg. C, Provo, UT 84604 2019-04-04
1255813325 Hwigeum Jeong Specialist/Technologist Department of Exercise Sciences 106 Sfh Brigham Young, Provo, UT 84604 2018-09-05
1093203044 Snowcap Smile Studio LLC Dentist 2230 N. University Pkwy Ste 8b, Provo, UT 84604 2018-04-25
1407359078 Ihc Health Services Inc Clinic/Center 380 W Bulldog Blvd, Ste 403, Provo, UT 84604 2018-03-09
1902308455 Afton Leuga Nurse Practitioner 395 W Bulldog Blvd., Suite 401, Provo, UT 84604 2018-03-01
1851807333 Ihc Health Services Inc Family Medicine 380 W 1230 N, Ste 602, Provo, UT 84604 2017-12-20
1689180218 Ihc Health Services Inc Pediatrics 395 W Bulldog Blvd Ste 703, Provo, UT 84604 2017-12-19
1396254165 Nicolas Sorensen Massage Therapist 247 West 2230 North #201, Provo, UT 84604 2017-09-25
1437692241 Cirque Lodge Inc Substance Abuse Rehabilitation Facility 3114 E Ida's Road, Sundance, UT 84604 2016-11-28
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Taxonomy Information

Taxonomy Code 133V00000X
Grouping Dietary & Nutritional Service Providers
Classification Dietitian, Registered

Taxonomy Definition

A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor’s degree at a US regionally accredited university or college and course work approved by The American Dietetic Association (ADA); an ADA-accredited or approved, supervised practice program, typically 6 to 12 months in length; a national examination administered by the Commission on Dietetic Registration; and continuing professional educational requirements to maintain registration.
Notes: Source: The American Dietetic Association. Becoming a Registered Dietitian – a food and nutrition expert. Chicago, IL: The American Dietetic Association, July 1997.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1114554060 Kristen Johnson Dietitian, Registered 395 W Cougar Blvd Ste 203, Provo, UT 84604-3328 2020-03-23
1225297419 Mindy Crockett Dietitian, Registered 395 W Bulldog Blvd, Provo, UT 84604-3311 2008-06-03
1609067347 Anna B Snyder Dietitian, Registered 1675 North Freedom Blvd Suite 15, Provo, UT 84604 2007-08-07
1477188811 Jodi Benson Dietitian, Registered 1034 N 500 W, Provo, UT 84604-3380 2020-03-05
1588217038 Anna-marie Ayotte Dietitian, Registered 1034 N 500 W, Provo, UT 84604-3380 2019-07-23
1770040263 Jill Austad Dietitian, Registered 1034 N 500 W, Provo, UT 84604-3380 2019-02-21
1255805123 Jillian Elaine Taylor Porto Dietitian, Registered 1034 N 500 W, Provo, UT 84604-3337 2019-01-14
1497249122 Linda Griffiths Saxton Dietitian, Registered 306 River Bend Ln, Provo, UT 84604-5625 2018-06-16
1851802490 Megan M. Kennedy Dietitian, Registered 1055 N 500 W Bldg A, Provo, UT 84604-3305 2017-10-23
1134647977 Daniel Burgess Dietitian, Registered 1034 N 500 W, Provo, UT 84604-3380 2017-08-31
Find all providers in PROVO

Competitor

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City PROVO
Zip Code 84604

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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