Lisa a Kennedy, Rd LLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

DT07616 Issued in TX

Legal business name

LISA A KENNEDY, RD LLC

Practice address

4635 NE Stallings Dr Ste 104
Nacogdoches, TX 75965-1667

Phone

(936) 628-9123

NPI assigned

Aug 26, 2018

Last updated

Aug 26, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lisa A Kennedy, RDNPI 1710296009

Title

Sole Member

Phone

(936) 628-9123

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lisa Kennedy, RD, LD

  • Registered Dietitian
  • Nacogdoches, TX
  • NPI 1710296009
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1535241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1535241600000",
    "number": "1861973091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 538",
            "city": "ETOILE",
            "state": "TX",
            "postal_code": "759440538",
            "telephone_number": "936-628-9123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4635 NE STALLINGS DR STE 104",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759651667",
            "telephone_number": "936-628-9123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LISA A KENNEDY, RD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-26",
        "last_updated": "2018-08-26",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "936-628-9123",
        "authorized_official_credential": "RD"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": "TX",
            "license": "DT07616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Registered Dietitian in Nacogdoches, TX
• Providers in Nacogdoches, TX by specialty
• Registered Dietitian in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 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.

Verify at the official NPI Registry.