Active NPI
Shannon Dawn Ledbetter, RD
- Registered Dietitian
- Benton, AR
National Provider Identifier
1730103540
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 834
- Practice address
- 1 Medical Park Dr
Benton, AR 72015-3353 - Phone
- (501) 776-6000
- NPI assigned
- Jul 26, 2006
- 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 | 834 | AR | Primary |
Addresses
Primary practice location
1 Medical Park Dr
Benton, AR 72015-3353
Mailing address
209 Hunters Run Dr
Benton, AR 72015-6590
Phone (501) 776-8391
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1730103540",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "209 HUNTERS RUN DR",
"city": "BENTON",
"state": "AR",
"postal_code": "720156590",
"telephone_number": "501-776-8391"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 MEDICAL PARK DR",
"city": "BENTON",
"state": "AR",
"postal_code": "720153353",
"telephone_number": "501-776-6000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEDBETTER",
"first_name": "SHANNON",
"middle_name": "DAWN",
"credential": "RD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "AR",
"license": "834",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Benton, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.