KODY MICHAEL DUCLOS RD LD NPI 1033748124

NPI Information

NPI: 1033748124
Provider Name: KODY MICHAEL DUCLOS, RD, LD
Classification: Dietitian, Registered - 133VN1004X
Entity Type: Individual

Specialization: Nutrition, Pediatric

Address:
305 E JEFFERSON ST
BOISE, ID
ZIP 83712
Phone: (208) 381-7081
Get Directions

Kody Michael Duclos, RD, LD is a nutrition and pediatric dietitian registered in Boise, ID. The provider is an individual who is a Board Certified Specialist in Pediatric Nutrition and applies evidence-based nutrition knowledge in providing medical nutrition therapy for pediatric patients. Specialists work directly with healthy and/or ill children (newborn up to 21 years of age) as well as children with special health care needs in a variety of settings (hospitals, community-based and/or family-centered programs, education programs, home, etc.), OR indirectly through management, care coordination, education, quality improvement, or research practice linked specifically to pediatric nutrition. Kody Michael Duclos, RD, LD NPI is 1033748124. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

305 E JEFFERSON ST
BOISE, ID
ZIP 83712-231
Phone: (208) 381-7081

The enumeration date for this NPI number is 4/2/2020 and was last updated on 4/2/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	133VN1004X	Dietitian, Registered	Nutrition, Pediatric	86117056	IDAHO	Yes
2	133VN1301X	Dietitian, Registered	Nutrition, Oncology	86117056	IDAHO	No
3	133VN1401X	Dietitian, Registered	Nutrition, Pediatric Critical Care	86117056	IDAHO	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	86117056	OTHER	IDAHO	COMMISSION ON DIETETIC REGISTRATION

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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