Active NPI
Bandy Jo Rackley, RD, LD
- Renal Nutrition Registered Dietitian
- Lawton, OK
National Provider Identifier
1033188743
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Renal Nutrition Registered Dietitian
- Practice address
- 5110 W Gore Blvd
Lawton, OK 73505-5909 - Phone
- (580) 713-3123
- NPI assigned
- Mar 15, 2006
- 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 |
|---|---|---|---|---|
| Renal Nutrition Registered Dietitian | 133VN1005X | Primary |
Addresses
Primary practice location
5110 W Gore Blvd
Lawton, OK 73505-5909
Mailing address
PO Box 485
Medicine Park, OK 73557-0485
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142380800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658448000000",
"number": "1033188743",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 485",
"city": "MEDICINE PARK",
"state": "OK",
"postal_code": "735570485"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5110 W GORE BLVD",
"city": "LAWTON",
"state": "OK",
"postal_code": "735055909",
"telephone_number": "580-713-3123"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RACKLEY",
"first_name": "BANDY",
"middle_name": "JO",
"name_prefix": "Ms.",
"credential": "RD, LD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-15",
"last_updated": "2022-07-22",
"certification_date": "2022-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "133VN1005X",
"taxonomy_group": "",
"desc": "Dietitian, Registered, Nutrition, Renal",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lawton, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.