Active NPI
Marti Bordenlon Vandagriff, RDN LDN CDCES
- Registered Dietitian
- Ruston, LA
National Provider Identifier
1417574294
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 1254
- Practice address
- 707 S Vienna St
Ruston, LA 71270 - Phone
- (318) 224-3044
- NPI assigned
- Jun 29, 2020
- 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 | 1254 | LA | Primary |
Addresses
Primary practice location
707 S Vienna St
Ruston, LA 71270
Mailing address
626 Whitefield Lane
Bossier City, LA 71112
Phone (318) 780-0530
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1254 | LA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1593388800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1593388800000",
"number": "1417574294",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "626 WHITEFIELD LANE",
"city": "BOSSIER CITY",
"state": "LA",
"postal_code": "71112",
"telephone_number": "318-780-0530"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "707 S VIENNA ST",
"city": "RUSTON",
"state": "LA",
"postal_code": "71270",
"telephone_number": "318-224-3044"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDAGRIFF",
"first_name": "MARTI",
"middle_name": "BORDENLON",
"name_prefix": "Ms.",
"credential": "RDN LDN CDCES",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-06-29",
"last_updated": "2020-06-29",
"certification_date": "2020-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "LA",
"license": "1254",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ruston, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.