Omni Nutrition LLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

ND6015 Issued in FL

Legal business name

OMNI NUTRITION LLC

Practice address

404 United Drive
New Smyrna Beach, FL 32168

Phone

(386) 968-2170

Fax

(386) 310-0587

NPI assigned

Jan 23, 2017

Organization subpart

No

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

Authorized official

Name

Lara L Clevenger, RDNPI 1497013320

Title

Owner

Phone

(686) 968-2170

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lara L Clevenger, RD

  • Registered Dietitian
  • New Smyrna Beach, FL
  • NPI 1497013320

  Dietitian, Registered

  NPD Authorized official

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

{
    "created_epoch": "1485129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754870400000",
    "number": "1104363605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3126 TAMARIND DRIVE",
            "city": "EDGEWATER",
            "state": "FL",
            "postal_code": "321416008",
            "telephone_number": "386-968-2170",
            "fax_number": "386-310-0587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 UNITED DRIVE",
            "city": "NEW SMYRNA BEACH",
            "state": "FL",
            "postal_code": "32168",
            "telephone_number": "386-968-2170",
            "fax_number": "386-310-0587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMNI NUTRITION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-23",
        "last_updated": "2025-08-11",
        "status": "A",
        "authorized_official_last_name": "CLEVENGER",
        "authorized_official_first_name": "LARA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "686-968-2170",
        "authorized_official_credential": "RD"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": "FL",
            "license": "ND6015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ocean View Care and Rehabilitation Center LLC
• Ocean View Nursing & Rehabilitation Center LLC
• Oceanside Wellness PLLC
• Beibei Oelrich, M.D. PHD
• Jerry L. Oestmann, PH.D.
• Jennifer L Onyski, PA
• Ormond Medical Arts
• Jacqueline Ortega, D.M.D
• Carly Nicole Osborn, DC
• Kilby P Osborn IV, MD

• Registered Dietitian in New Smyrna Beach, FL
• Providers in New Smyrna Beach, FL by specialty
• Registered Dietitian in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2025; 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.