Active NPI
Jessica Michelle Stark, MS, RDN, LDN
- Nutritionist
- West Monroe, LA
National Provider Identifier
1730650755
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutritionist
- License
- 1095239
- Practice address
- 118 Temecula Dr
West Monroe, LA 71292-0476 - Phone
- (318) 557-9329
- NPI assigned
- Dec 17, 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 |
|---|---|---|---|---|
| Nutritionist | 133N00000X | 1095239 | LA | Primary |
Addresses
Primary practice location
118 Temecula Dr
West Monroe, LA 71292-0476
Mailing address
118 Temecula Dr
West Monroe, LA 71292-0476
Phone (318) 557-9329
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1095239 | LA | MD | Nutritionist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1545004800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1545004800000",
"number": "1730650755",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "118 TEMECULA DR",
"city": "WEST MONROE",
"state": "LA",
"postal_code": "712920476",
"telephone_number": "318-557-9329"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "118 TEMECULA DR",
"city": "WEST MONROE",
"state": "LA",
"postal_code": "712920476",
"telephone_number": "318-557-9329"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STARK",
"first_name": "JESSICA",
"middle_name": "MICHELLE",
"name_prefix": "Ms.",
"credential": "MS, RDN, LDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-12-17",
"last_updated": "2018-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": "LA",
"license": "1095239",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Monroe, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 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.