Lara K Peck, RD CDE

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

871969 Issued in VT

Practice address

275 Route 30 N
Bomoseen, VT 05732-9647

Phone

(802) 468-5641

Fax

(802) 468-2923

NPI assigned

Jan 4, 2012

Last updated

Jan 4, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ms. Lara K Borders Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1325635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325635200000",
    "number": "1063782340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 ROUTE 30 N",
            "city": "BOMOSEEN",
            "state": "VT",
            "postal_code": "057329647",
            "telephone_number": "802-468-5641",
            "fax_number": "802-468-2923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 ROUTE 30 N",
            "city": "BOMOSEEN",
            "state": "VT",
            "postal_code": "057329647",
            "telephone_number": "802-468-5641",
            "fax_number": "802-468-2923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PECK",
        "first_name": "LARA",
        "middle_name": "K",
        "name_prefix": "Mrs.",
        "credential": "RD CDE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-01-04",
        "last_updated": "2012-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "VT",
            "license": "871969",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LARA",
            "last_name": "BORDERS",
            "middle_name": "K",
            "prefix": "MS.",
            "credential": "RD CDE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Gabrielle Myrick, FNP
• Jill V Read, PNP
• Nicole Ashley Reda
• Michele Marie Redmond, RN, BSN, CDE
• Laurel Reed-Becksted
• Stephen Marion Rosmus, MD

• Registered Dietitian in Bomoseen, VT
• Providers in Bomoseen, VT by specialty
• Registered Dietitian in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.