Active NPI
Joleen Wilson, RD/LD
- Registered Dietitian
- Broken Arrow, OK
National Provider Identifier
1528293586
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 1842
- Practice address
- 6336 S 116TH East Ave
Broken Arrow, OK 74012-1251 - Phone
- (918) 280-8456
- Fax
- (855) 438-6802
- NPI assigned
- May 20, 2009
- 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 1842 | OK | Primary |
Addresses
Primary practice location
6336 S 116TH East Ave
Broken Arrow, OK 74012-1251
Mailing address
1701 S Main St
PMB 2735
Broken Arrow, OK 74013-9701
Phone (918) 280-8456
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1842 | Other | OK | LD |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1842 | OK | MD | Orthopaedic Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Meals by Joleen LLC | Dietitian, Registered | Current | Accepting new patients |
Locations
1701 S Main St
Unit 2735
Broken Arrow, OK 74013
8988 S Sheridan Rd
Ste F
Tulsa, OK 74133
Phone (918) 861-4973
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1242777600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1703980800000",
"number": "1528293586",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1701 S MAIN ST",
"address_2": "PMB 2735",
"city": "BROKEN ARROW",
"state": "OK",
"postal_code": "740139701",
"telephone_number": "918-280-8456",
"fax_number": "855-438-6802"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6336 S 116TH EAST AVE",
"city": "BROKEN ARROW",
"state": "OK",
"postal_code": "740121251",
"telephone_number": "918-280-8456",
"fax_number": "855-438-6802"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JOLEEN",
"credential": "RD/LD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-05-20",
"last_updated": "2023-12-31",
"certification_date": "2023-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "OK",
"license": "1842",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LD",
"identifier": "1842",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Broken Arrow, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.