Active NPI
Laura Mangum, R.D., L.D.
- Registered Dietitian
- Austin, TX
National Provider Identifier
1255543989
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DT05397
- Practice address
- 15808 Hwy 620 North
Suite 100
Austin, TX 78717 - Phone
- (512) 731-8679
- NPI assigned
- May 4, 2007
- 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 | DT05397 | TX | Primary |
Addresses
Primary practice location
15808 Hwy 620 North
Suite 100
Austin, TX 78717
Mailing address
4432 Pasada LN
Round Rock, TX 78681-1683
Phone (512) 731-8679
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 |
|---|---|---|---|
| DT05397 | TX | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1255543989",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4432 PASADA LN",
"city": "ROUND ROCK",
"state": "TX",
"postal_code": "786811683",
"telephone_number": "512-731-8679",
"fax_number": "512-238-1946"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15808 HWY 620 NORTH",
"address_2": "SUITE 100",
"city": "AUSTIN",
"state": "TX",
"postal_code": "78717",
"telephone_number": "512-731-8679"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANGUM",
"first_name": "LAURA",
"credential": "R.D., L.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "TX",
"license": "DT05397",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.