Susan Clark, MS, RD, LD, CDE
NPI 1124676663 · Registered Dietitian · Rexburg, ID
Enrolled with Medicare as Practitioner - Registered Dietitian Or Nutrition Professional · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Provider details
- NPI number
- 1124676663
- Entity type
- Individual
- Primary specialty
- Registered DietitianDietary & Nutritional Service Providers
- Credential
- MS, RD, LD, CDE
- Sex
- Female
- Sole proprietor
- No
- License
- D-393 (ID)
Specialties & taxonomies
Dietary & Nutritional Service Providers
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
6 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
2 documented practice locations
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Additional practice locations (1)
- 450 E Main StRexburg, ID 83440-2048Phone: (208) 359-6522
Registry dates
- Enumerated
- 2019-08-28
- Last updated
- 2025-11-24
- Certified
- 2025-11-24
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.