Petra Hayley Colindres, MA,RDN/LD,IBCLC,CPT

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

LP2053 Issued in OK

Practice address

4129 NW 45TH St
Okc, OK 73112

Phone

(858) 352-8354

NPI assigned

Aug 3, 2015

Last updated

Apr 26, 2017By 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 4

Addresses

Other names 1

• Mrs. Petra Hayley Lusche Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

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.

• Nutrition by Petra

  • Registered Dietitian
  • Norman, OK
  • NPI 1316445570
  Authorized official Same address or phone

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

{
    "created_epoch": "1438560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493164800000",
    "number": "1407232317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4129 NW 45TH ST",
            "city": "OKC",
            "state": "OK",
            "postal_code": "73112",
            "telephone_number": "858-352-8354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4129 NW 45TH ST",
            "city": "OKC",
            "state": "OK",
            "postal_code": "73112",
            "telephone_number": "858-352-8354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLINDRES",
        "first_name": "PETRA",
        "middle_name": "HAYLEY",
        "name_prefix": "Mrs.",
        "credential": "MA,RDN/LD,IBCLC,CPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-08-03",
        "last_updated": "2017-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133NN1002X",
            "taxonomy_group": "",
            "desc": "Nutritionist, Nutrition, Education",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "OK",
            "license": "LP2053",
            "primary": true
        },
        {
            "code": "133VN1004X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Pediatric",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133VN1006X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PETRA",
            "last_name": "LUSCHE",
            "middle_name": "HAYLEY",
            "prefix": "MRS.",
            "credential": "MA,RDN/LD,IBCLC,CPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Board of Regents of the Univ of Oklahoma-Ou Physicians Latino Clinic
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• Registered Dietitian in Okc, OK
• Providers in Okc, OK by specialty
• Registered Dietitian in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2017; 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.