Active NPI
Jennifer Lynn Stavig, M.S., R.D.
- Registered Dietitian
- Lake City, FL
National Provider Identifier
1457462905
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- ND3302
- Practice address
- 619 S Marion Ave
Lake City, FL 32025-5808 - Phone
- (386) 755-3016
- NPI assigned
- Aug 31, 2006
- 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 | ND3302 | FL | Primary |
Addresses
Primary practice location
619 S Marion Ave
Lake City, FL 32025-5808
Mailing address
11466 75TH Loop
Live Oak, FL 32060-7121
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ND3302 | FL | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1457462905",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11466 75TH LOOP",
"city": "LIVE OAK",
"state": "FL",
"postal_code": "320607121"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "619 S MARION AVE",
"city": "LAKE CITY",
"state": "FL",
"postal_code": "320255808",
"telephone_number": "386-755-3016"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STAVIG",
"first_name": "JENNIFER",
"middle_name": "LYNN",
"credential": "M.S., R.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "FL",
"license": "ND3302",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake City, FL
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.