Active NPI
Jordan A Lichthardt
- Registered Dietitian
- Los Alamos, NM
National Provider Identifier
1619449766
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- LD-1195
- Practice address
- 3917 West Rd Ste a
Los Alamos, NM 87544-2292 - Phone
- (505) 661-8900
- Fax
- (505) 661-8916
- NPI assigned
- Dec 28, 2018
- Last updated
- Dec 28, 2018
- 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 | LD-1195 | NM | Primary |
Addresses
Primary practice location
3917 West Rd Ste a
Los Alamos, NM 87544-2292
Mailing address
3917 West Rd Ste a
Los Alamos, NM 87544-2292
Phone (505) 661-8900
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 |
|---|---|---|---|
| LD-1195 | NM | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1545955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1545955200000",
"number": "1619449766",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3917 WEST RD STE A",
"city": "LOS ALAMOS",
"state": "NM",
"postal_code": "875442292",
"telephone_number": "505-661-8900",
"fax_number": "505-661-8916"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3917 WEST RD STE A",
"city": "LOS ALAMOS",
"state": "NM",
"postal_code": "875442292",
"telephone_number": "505-661-8900",
"fax_number": "505-661-8916"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LICHTHARDT",
"first_name": "JORDAN",
"middle_name": "A",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-12-28",
"last_updated": "2018-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NM",
"license": "LD-1195",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Alamos, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.