LISA A KENNEDY, RD LLC — NPI 1861973091 (Licensed & Credentialed Dietary & Nutritional Service Providers — Dietician, Registered in NACOGDOCHES, TX)

CMS-1500 Box 24J / 33a • NPI

1861973091

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

133V00000X (CMS 71)

Licensed & Credentialed Dietary & Nutritional Service Providers — Dietician, Registered

Box 32 Service Location & ZIP+4

4635 NE STALLINGS DR STE 104, NACOGDOCHES, TX, 75965-1667

✓ 9-Digit EDI 837 ZIP+4 (75965-1667)

Practice Phone & Referral Fax

(936) 628-9123

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1861973091 (LISA A KENNEDY, RD LLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1861973091` (NPI-2 Organization / Facility)
Provider / Legal Name	LISA A KENNEDY, RD LLC
Plain-English Specialty	Licensed & Credentialed Dietary & Nutritional Service Providers — Dietician, Registered NUCC Code: `133V00000X` (Dietitian, Registered)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	4635 NE STALLINGS DR STE 104, NACOGDOCHES, TX, 75965-1667
Practice Telephone / Fax	Tel: (936) 628-9123
Administrative Mailing Address	PO BOX 538, ETOILE, TX, 75944-0538
Enumeration & Last Sync	Enumerated: 2018-08-26 \| CMS Record Updated: 2018-08-26
Authorized Official	LISA KENNEDY (Sole Member)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

4635 NE STALLINGS DR STE 104, NACOGDOCHES, TX, 75965-1667

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Plain-English Taxonomy & CMS Crosswalk (133V00000X)

What Does Taxonomy Code 133V00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 133V00000X translates to:
"Licensed & Credentialed Dietary & Nutritional Service Providers — Dietician, Registered"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 71 (Registered Dietitian or Nutrition Professional)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Dietitian, Registered for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (LISA A KENNEDY, RD LLC)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`133V00000X` — Dietitian, Registered Plain English: Licensed & Credentialed Dietary & Nutritional Service Providers — Dietician, Registered	State: TX \| License: `DT07616` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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LISA A KENNEDY, RD LLC (NPI #1861973091)