Active NPI
Stacey Pardue, PT
- Registered Dietitian
- Monroe, LA
National Provider Identifier
1376096636
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 1014
- Practice address
- 1325 Louisville Ave
Monroe, LA 71201-6021 - Phone
- (318) 807-1500
- Fax
- (318) 807-1504
- NPI assigned
- Aug 3, 2016
- 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 | 1014 | LA | Primary |
Addresses
Primary practice location
1325 Louisville Ave
Monroe, LA 71201-6021
Mailing address
130 Desiard St
Suite 355
Monroe, LA 71201-7319
Phone (318) 807-7875
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 |
|---|---|---|---|
| 1014 | LA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1470182400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1470182400000",
"number": "1376096636",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "130 DESIARD ST",
"address_2": "SUITE 355",
"city": "MONROE",
"state": "LA",
"postal_code": "712017319",
"telephone_number": "318-807-7875",
"fax_number": "318-812-6603"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1325 LOUISVILLE AVE",
"city": "MONROE",
"state": "LA",
"postal_code": "712016021",
"telephone_number": "318-807-1500",
"fax_number": "318-807-1504"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARDUE",
"first_name": "STACEY",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-08-03",
"last_updated": "2016-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "LA",
"license": "1014",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Monroe, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.