Active NPI
Travis Colton Eden, RDN
- Registered Dietitian
- Owasso, OK
National Provider Identifier
1104535012
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 2512
- Practice address
- 10301 N 98TH East Ave
Owasso, OK 74055-7883 - Phone
- (479) 787-0811
- NPI assigned
- Nov 18, 2022
- Sex
- Male
- 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 | 2512 | OK | Primary |
Addresses
Primary practice location
10301 N 98TH East Ave
Owasso, OK 74055-7883
Mailing address
1819 E 19TH St
Tulsa, OK 74104-5407
Phone (918) 744-3624
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 |
|---|---|---|---|
| 2512 | OK | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1668729600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1668729600000",
"number": "1104535012",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1819 E 19TH ST",
"city": "TULSA",
"state": "OK",
"postal_code": "741045407",
"telephone_number": "918-744-3624"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10301 N 98TH EAST AVE",
"city": "OWASSO",
"state": "OK",
"postal_code": "740557883",
"telephone_number": "479-787-0811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDEN",
"first_name": "TRAVIS",
"middle_name": "COLTON",
"credential": "RDN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-11-18",
"last_updated": "2022-11-18",
"certification_date": "2022-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "OK",
"license": "2512",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Owasso, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 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.