Provider Demographics
NPI:1952541039
Name:STANSBURY, LISA A (MS, LDN, RD, CDE)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:STANSBURY
Suffix:
Gender:F
Credentials:MS, LDN, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 E. BERT KOUNS
Mailing Address - Street 2:HIGHLAND CLINIC, APMC
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105
Mailing Address - Country:US
Mailing Address - Phone:318-795-4715
Mailing Address - Fax:318-795-4719
Practice Address - Street 1:1455 E. BERT KOUNS
Practice Address - Street 2:HIGHLAND CLINIC, APMC
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105
Practice Address - Country:US
Practice Address - Phone:318-795-4715
Practice Address - Fax:318-795-4719
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA429133V00000X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3B0076742Medicare PIN