Active NPI
Lisa Funk Hodges, RDN
- Registered Dietitian
- Winston Salem, NC
National Provider Identifier
1043077415
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- L007465
- Practice address
- 4610 Country Club Rd
Winston Salem, NC 27104-3520 - Phone
- (336) 716-8234
- NPI assigned
- Mar 4, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | L007465 | NC | Primary |
Addresses
Primary practice location
4610 Country Club Rd
Winston Salem, NC 27104-3520
Mailing address
5290 Funk Farm LN
Winston Salem, NC 27106-4586
Phone (336) 287-5596
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L007465 | NC | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1709510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1709510400000",
"number": "1043077415",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5290 FUNK FARM LN",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271064586",
"telephone_number": "336-287-5596"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4610 COUNTRY CLUB RD",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271043520",
"telephone_number": "336-716-8234"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HODGES",
"first_name": "LISA",
"middle_name": "FUNK",
"credential": "RDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-03-04",
"last_updated": "2024-03-04",
"certification_date": "2024-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NC",
"license": "L007465",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winston Salem, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.