Active NPI
Lara L Clevenger, RD
- Registered Dietitian
- New Smyrna Beach, FL
National Provider Identifier
1497013320
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- ND6015
- Practice address
- 404 United Drive
New Smyrna Beach, FL 32168 - Phone
- (386) 968-2170
- Fax
- (386) 310-0587
- NPI assigned
- Apr 28, 2012
- Last updated
- Aug 11, 2025
- 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 | ND6015 | FL | Primary |
Addresses
Primary practice location
404 United Drive
New Smyrna Beach, FL 32168
Mailing address
3126 Tamarind Drive
Edgewater, FL 32141
Phone (386) 968-2170
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Omni Nutrition LLC | Dietitian, Registered | Current | Accepting new patients |
Locations
404 United Dr
New Smyrna Beach, FL 32168
Phone (386) 968-2170
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1335571200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1754870400000",
"number": "1497013320",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3126 TAMARIND DRIVE",
"city": "EDGEWATER",
"state": "FL",
"postal_code": "32141",
"telephone_number": "386-968-2170",
"fax_number": "386-310-0587"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "404 UNITED DRIVE",
"city": "NEW SMYRNA BEACH",
"state": "FL",
"postal_code": "32168",
"telephone_number": "386-968-2170",
"fax_number": "386-310-0587"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLEVENGER",
"first_name": "LARA",
"middle_name": "L",
"credential": "RD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-04-28",
"last_updated": "2025-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "FL",
"license": "ND6015",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Smyrna Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.