Active NPI
Cortney Taylor Larsen, RDN
- Registered Dietitian
- Grand Rapids, MI
National Provider Identifier
1750136164
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86100007
- Practice address
- 2747 4 Mile Rd NW
Grand Rapids, MI 49544-9207 - Phone
- (231) 519-0273
- NPI assigned
- Apr 19, 2024
- 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 | 86100007 | MI | Primary |
Addresses
Primary practice location
2747 4 Mile Rd NW
Grand Rapids, MI 49544-9207
Mailing address
2747 4 Mile Rd NW
Grand Rapids, MI 49544-9207
Phone (231) 519-0273
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 |
|---|---|---|---|
| 86100007 | MI | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gray Space Nutrition LLC | Dietitian, Registered | Current | Accepting new patients |
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1713484800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1713484800000",
"number": "1750136164",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2747 4 MILE RD NW",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495449207",
"telephone_number": "231-519-0273"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2747 4 MILE RD NW",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495449207",
"telephone_number": "231-519-0273"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSEN",
"first_name": "CORTNEY",
"middle_name": "TAYLOR",
"credential": "RDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-04-19",
"last_updated": "2024-04-19",
"certification_date": "2024-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MI",
"license": "86100007",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.