Active NPI
Laura Ann Ivy, LDN RD
- Registered Dietitian
- Shreveport, LA
National Provider Identifier
1063480366
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 884597
- Practice address
- 510 E Stoner Ave
Shreveport, LA 71101-4243 - Phone
- (318) 221-8411
- Fax
- (318) 429-5724
- NPI assigned
- Mar 10, 2006
- 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 | 884597 | LA | Primary |
Addresses
Primary practice location
510 E Stoner Ave
Shreveport, LA 71101-4243
Mailing address
4111 Pines Rd
Shreveport, LA 71119-7315
Phone (318) 631-4109
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 |
|---|---|---|---|
| 884597 | LA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141948800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184198400000",
"number": "1063480366",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4111 PINES RD",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711197315",
"telephone_number": "318-631-4109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "510 E STONER AVE",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711014243",
"telephone_number": "318-221-8411",
"fax_number": "318-429-5724"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IVY",
"first_name": "LAURA",
"middle_name": "ANN",
"credential": "LDN RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-10",
"last_updated": "2007-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "LA",
"license": "884597",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.