Active NPI
Kelly Wilson, MS, RD, LD, CSO
- Registered Dietitian
- Houston, TX
National Provider Identifier
1588268429
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86041805
- Practice address
- 1242 Demaret LN
Houston, TX 77055-6136 - Phone
- (254) 493-5962
- NPI assigned
- Nov 22, 2020
- 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 |
|---|---|---|---|---|
| Oncology Nutrition Registered Dietitian | 133VN1301X | |||
| Registered Dietitian | 133V00000X | 86041805 | TX | Primary |
Addresses
Primary practice location
1242 Demaret LN
Houston, TX 77055-6136
Mailing address
1242 Demaret LN
Houston, TX 77055-6136
Phone (254) 493-5962
Other names 1
- Kelly Johnson
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86041805 | TX | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Greater Houston Nutrition | Dietitian, Registered | Current | 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1606003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606003200000",
"number": "1588268429",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1242 DEMARET LN",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770556136",
"telephone_number": "254-493-5962"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1242 DEMARET LN",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770556136",
"telephone_number": "254-493-5962"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "KELLY",
"credential": "MS, RD, LD, CSO",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-11-22",
"last_updated": "2020-11-22",
"certification_date": "2020-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "133VN1301X",
"taxonomy_group": "",
"desc": "Dietitian, Registered, Nutrition, Oncology",
"state": null,
"license": null,
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "TX",
"license": "86041805",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KELLY",
"last_name": "JOHNSON",
"credential": "RD, LD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.