Active NPI
Lavon Sue Lewis, L.D.R.D.
- Registered Dietitian
- Tahlequah, OK
National Provider Identifier
1205928751
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 49
- Practice address
- 712 Janet St
Tahlequah, OK 74464-7118 - Phone
- (918) 456-6230
- Fax
- (918) 456-6230
- NPI assigned
- Sep 29, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 | 49 | OK | Primary |
Addresses
Primary practice location
712 Janet St
Tahlequah, OK 74464-7118
Mailing address
712 Janet St
Tahlequah, OK 74464-7118
Phone (918) 456-6230
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OK
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20091006000423 | OK | Practitioner - Registered Dietitian Or Nutrition Professional | 6406992452 | Practice locations: Tahlequah, OK |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1205928751",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "712 JANET ST",
"city": "TAHLEQUAH",
"state": "OK",
"postal_code": "744647118",
"telephone_number": "918-456-6230",
"fax_number": "918-456-6230"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "712 JANET ST",
"city": "TAHLEQUAH",
"state": "OK",
"postal_code": "744647118",
"telephone_number": "918-456-6230",
"fax_number": "918-456-6230"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEWIS",
"first_name": "LAVON",
"middle_name": "SUE",
"name_prefix": "Ms.",
"credential": "L.D.R.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "OK",
"license": "49",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tahlequah, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.