Lisa Anne Wyckoff, RD, CSR, LD

Primary specialty

Renal Nutrition Registered DietitianTaxonomy code 133VN1005X

License

ND2626 Issued in FL

Practice address

7415 W Gulf to Lake Hwy
Crystal River, FL 34429-7834

Phone

(352) 795-1415

Fax

(352) 564-0147

NPI assigned

Jan 24, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Miss Lisa Anne Barton Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Citrus Nephrology Associates Inc

  • Nephrology Physician
  • Crystal River, FL
  • NPI 1528116027
  NPD (past)

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1396890273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 SHUMARD CT S",
            "city": "HOMOSASSA",
            "state": "FL",
            "postal_code": "344464720",
            "telephone_number": "352-382-2048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7415 W GULF TO LAKE HWY",
            "city": "CRYSTAL RIVER",
            "state": "FL",
            "postal_code": "344297834",
            "telephone_number": "352-795-1415",
            "fax_number": "352-564-0147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYCKOFF",
        "first_name": "LISA",
        "middle_name": "ANNE",
        "name_prefix": "Mrs.",
        "credential": "RD, CSR, LD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133VN1005X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Renal",
            "state": "FL",
            "license": "ND2626",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00025278",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "BARTON",
            "middle_name": "ANNE",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Claire Annette Wirt, LMT
• Linda Lee Witherow, D.D.S.
• Celeste Mendonca Wolf, LMT
• Susana Wolmarans, MD
• Wonder Kid Care LLC
• Sharon C Ybanez Sanchez, RPT
• Ruth Young, SLP
• Tonia Lea Zelik
• David Zepf, PHARMD
• Nichole Zevallos, OTR

• Renal Nutrition Registered Dietitian in Crystal River, FL
• Providers in Crystal River, FL by specialty
• Renal Nutrition Registered Dietitian in Florida

• 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.

Verify at the official NPI Registry.