{"npi":"1073056545","type":"NPI-1","status":"active","name":{"display":"Kallie Siderewicz Rdn","other":[],"first":"KALLIE","last":"SIDEREWICZ","middle":"MARIE","credential":"RDN"},"specialty":{"primary_taxonomy":"133V00000X","primary_taxonomy_description":"Registered Dietitian","slug":"registered-dietitian","schema_org_specialty":null,"all":[{"code":"133V00000X","description":"Registered Dietitian","primary":true,"state":"AZ","license":"86009790"}]},"addresses":[{"purpose":"LOCATION","street_1":"5301 E GRANT RD","city":"TUCSON","state":"AZ","postal_code":"857122805","country_code":"US","phone":"5207301582"},{"purpose":"MAILING","street_1":"PO BOX 31235","city":"TUCSON","state":"AZ","postal_code":"857511235","country_code":"US","phone":"5203244100"}],"license":{"state":"AZ","number":"86009790"},"identifiers":[{"type_code":"01","label":"Other","value":"86009790","state":"AZ","issuer":"RDN CERTIFICATE"},{"type_code":"05","label":"Medicaid","value":"220882","state":"AZ","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"I20170510002761","type_code":"14-71","type_desc":"PRACTITIONER - REGISTERED DIETITIAN OR NUTRITION PROFESSIONAL","state":"AZ","pac_id":"6103103692"}]},"enumeration_date":"2016-11-30","last_updated":"2021-09-14","_meta":{"source":"NPPES","snapshot_date":"2021-09-14","doc_url":"https://findmynpi.com/api"}}