Active NPI
Zack Kidd, RD
- Registered Dietitian
- Shreveport, LA
National Provider Identifier
1477987576
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 886
- Practice address
- 510 E Stoner Ave
Shreveport, LA 71101-4243 - Phone
- (318) 990-4084
- NPI assigned
- Aug 26, 2013
- Sex
- Male
- 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 | 886 | LA | Primary |
Addresses
Primary practice location
510 E Stoner Ave
Shreveport, LA 71101-4243
Mailing address
886 Oak Grove Church Rd
Gibsland, LA 71028-4594
Phone (940) 255-9249
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 886 | Other | LA | LOUISIANA DIETETIC ASSOCIATION |
| 727068 | Other | LA | AMERICAN DIETETIC ASSOCIATION |
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 |
|---|---|---|---|
| 886 | LA | MD | Intellectual & Developmental Disabilities Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1377475200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377475200000",
"number": "1477987576",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "886 OAK GROVE CHURCH RD",
"city": "GIBSLAND",
"state": "LA",
"postal_code": "710284594",
"telephone_number": "940-255-9249"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "510 E STONER AVE",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711014243",
"telephone_number": "318-990-4084"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIDD",
"first_name": "ZACK",
"credential": "RD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-08-26",
"last_updated": "2013-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "LA",
"license": "886",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LOUISIANA DIETETIC ASSOCIATION",
"identifier": "886",
"state": "LA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICAN DIETETIC ASSOCIATION",
"identifier": "727068",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.