Active NPI
Glenda Z McCraw, RD
- Registered Dietitian
- Laurel, MS
National Provider Identifier
1720089543
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- D0071
- Practice address
- 1220 Jefferson St
Laurel, MS 39440-4355 - Phone
- (601) 426-4083
- Fax
- (601) 426-4417
- NPI assigned
- Aug 2, 2005
- 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 | D0071 | MS | Primary |
Addresses
Primary practice location
1220 Jefferson St
Laurel, MS 39440-4355
Mailing address
24 Dean Matthews Rd
Laurel, MS 39443-8010
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 09432394 | Medicaid | MS |
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 |
|---|---|---|---|
| D0071 | MS | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1122940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1288742400000",
"number": "1720089543",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24 DEAN MATTHEWS RD",
"city": "LAUREL",
"state": "MS",
"postal_code": "394438010"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1220 JEFFERSON ST",
"city": "LAUREL",
"state": "MS",
"postal_code": "394404355",
"telephone_number": "601-426-4083",
"fax_number": "601-426-4417"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCRAW",
"first_name": "GLENDA",
"middle_name": "Z",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-08-02",
"last_updated": "2010-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MS",
"license": "D0071",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "09432394",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Laurel, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.