Active NPI
Kelly King, RD, LD, CDCES
- Registered Dietitian
- Southlake, TX
National Provider Identifier
1588425474
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DT81714
- Practice address
- 200 N Kimball Ave Ste 221
Southlake, TX 76092-6660 - Phone
- (817) 518-7239
- NPI assigned
- Jan 18, 2024
- 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 | DT81714 | TX | Primary |
Addresses
Primary practice location
200 N Kimball Ave Ste 221
Southlake, TX 76092-6660
Mailing address
3035 Wind Knot Way
Royse City, TX 75189-0500
Phone (214) 213-6217
Other practice location 1
3035 Wind Knot Way
Royse City, TX 75189-0500
Phone (214) 213-6217
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 |
|---|---|---|---|
| DT81714 | TX | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1705536000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724803200000",
"number": "1588425474",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3035 WIND KNOT WAY",
"city": "ROYSE CITY",
"state": "TX",
"postal_code": "751890500",
"telephone_number": "214-213-6217"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 N KIMBALL AVE STE 221",
"city": "SOUTHLAKE",
"state": "TX",
"postal_code": "760926660",
"telephone_number": "817-518-7239"
}
],
"practiceLocations": [
{
"address_1": "3035 Wind Knot Way",
"address_purpose": "LOCATION",
"city": "Royse City",
"state": "TX",
"postal_code": "751890500",
"country_code": "US",
"telephone_number": "214-213-6217",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KING",
"first_name": "KELLY",
"credential": "RD, LD, CDCES",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-01-18",
"last_updated": "2024-08-28",
"certification_date": "2024-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "TX",
"license": "DT81714",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southlake, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.