Active NPI
Kelly Harrelson, DDS
- Dentist
- Roanoke, TX
National Provider Identifier
1366935801
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 34055
- Practice address
- 1405 Cannon Pkwy
Roanoke, TX 76262-3620 - Phone
- (918) 413-2774
- NPI assigned
- Jun 10, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 7046 | OK | |
| Dentist | 122300000X | 34055 | TX | Primary |
Addresses
Primary practice location
1405 Cannon Pkwy
Roanoke, TX 76262-3620
Mailing address
3605 Country CLB
Moore, OK 73160-7615
Phone (918) 413-2774
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 |
|---|---|---|---|
| 7046 | OK | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kelly Harrelson DDS, PLLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dental Clinic/Center
- Roanoke, TX
- NPI 1205650264
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528588800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528588800000",
"number": "1366935801",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3605 COUNTRY CLB",
"city": "MOORE",
"state": "OK",
"postal_code": "731607615",
"telephone_number": "918-413-2774"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1405 CANNON PKWY",
"city": "ROANOKE",
"state": "TX",
"postal_code": "762623620",
"telephone_number": "918-413-2774"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRELSON",
"first_name": "KELLY",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-06-10",
"last_updated": "2018-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OK",
"license": "7046",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "34055",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roanoke, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 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.