Active NPI
Lisa Lauritzen Smith, RDN
- Registered Dietitian
- Jackson, WY
National Provider Identifier
1104464734
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 071
- Practice address
- 625 E Broadway Ave
Jackson, WY 83001-8642 - Phone
- (307) 739-7357
- NPI assigned
- Dec 13, 2019
- 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 | 071 | WY | Primary |
Addresses
Primary practice location
625 E Broadway Ave
Jackson, WY 83001-8642
Mailing address
PO Box 428
Jackson, WY 83001-0428
Phone (307) 739-7357
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 155572300 | Medicaid | WY |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | llsmith@sjmc.cernerdirect.com | Direct |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071 | WY | MD | Addiction (Substance Use Disorder) Counselor |
Interoperability endpoints
- llsmith@sjmc.cernerdirect.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1576195200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613606400000",
"number": "1104464734",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 428",
"city": "JACKSON",
"state": "WY",
"postal_code": "830010428",
"telephone_number": "307-739-7357"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "625 E BROADWAY AVE",
"city": "JACKSON",
"state": "WY",
"postal_code": "830018642",
"telephone_number": "307-739-7357"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "LISA",
"middle_name": "LAURITZEN",
"credential": "RDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-12-13",
"last_updated": "2021-02-18",
"certification_date": "2021-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "WY",
"license": "071",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "155572300",
"state": "WY"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "llsmith@sjmc.cernerdirect.com",
"affiliation": "N",
"endpointDescription": "Direct Messaging Address for St John's Health",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Other",
"address_1": "625 E Broadway Ave",
"city": "Jackson",
"state": "WY",
"country_code": "US",
"postal_code": "830018642",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Jackson, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.