Lisa Contreras Clarke, RD, CSSD

Primary specialty

Sports Dietetics Nutrition Registered DietitianTaxonomy code 133VN1501X

License

DT85055 Issued in TX

Practice address

211 Redbird Lane
Beaumont, TX 77705-9801

Phone

(409) 880-2359

NPI assigned

Nov 11, 2020

Last updated

Nov 11, 2020By 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 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1605052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605052800000",
    "number": "1497357859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "849 HARVARD ST APT D",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770071644",
            "telephone_number": "254-640-0612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 REDBIRD LANE",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777059801",
            "telephone_number": "409-880-2359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARKE",
        "first_name": "LISA",
        "middle_name": "CONTRERAS",
        "credential": "RD, CSSD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-11-11",
        "last_updated": "2020-11-11",
        "certification_date": "2020-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133VN1501X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Sports Dietetics",
            "state": "TX",
            "license": "DT85055",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Beaumont",
            "affiliation": "N",
            "endpointDescription": "Lamar University Athletics",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "athletic training and nutrition",
            "address_1": "211 Redbird Lane",
            "city": "Beaumont",
            "state": "TX",
            "country_code": "US",
            "postal_code": "777059801",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Charles B. Clark III, M.D.
• Jerry Doyle Clark, M.D.
• Joseph Clark, DC
• Linda Gaye Clark
• Burnet Todd Clarke, MD
• Clarus Imaging (Beaumont), LP
• Bobby Clay, PHARMD.
• Dylan James Clay, PHARMD
• Gary R Clayton, M.D.
• Cleburne Country LLC (Summer Place Nursing & Rehabilitation)

• Sports Dietetics Nutrition Registered Dietitian in Beaumont, TX
• Providers in Beaumont, TX by specialty
• Sports Dietetics Nutrition Registered Dietitian in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 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.

Verify at the official NPI Registry.