Kelsy Dieterich, CST/CSFA

Primary specialty

Surgical TechnologistTaxonomy code 246ZS0410X

License

178624 Issued in TX

Practice address

5100 Franklin Ave Ste C
Waco, TX 76710-6922

Phone

(254) 754-0375

Fax

(254) 754-2667

NPI assigned

May 25, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/11829/brand/1/csg/1/fhir/r4

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.

• Elite Sports Medicine Physical Therapy

  • Legal Medicine
  • Waco, TX
  • NPI 1740586015
  NPD
• Waco Bone & Joint Clinic, P.a.

  • Orthopaedic Surgery Physician
  • Waco, TX
  • NPI 1093917726
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1527206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527206400000",
    "number": "1639660533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5100 FRANKLIN AVE STE C",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767106922",
            "telephone_number": "254-754-0375",
            "fax_number": "254-754-2667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 FRANKLIN AVE STE C",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767106922",
            "telephone_number": "254-754-0375",
            "fax_number": "254-754-2667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETERICH",
        "first_name": "KELSY",
        "credential": "CST/CSFA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-25",
        "last_updated": "2018-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZS0410X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Technologist",
            "state": "TX",
            "license": "178624",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melanie Noreen Diaz, DO
• Nituna Diana Diaz
• Mark Hansen Dickie, M.D.
• Karen Lynn Dierolf, OTR, CHT
• Karleigh Dieterich, PT
• John Daly Dietrick, MD
• Digitrace Care Services, Inc
• Marc Alan Dildy, CRNA
• Lauren Michelle Dillavou
• Savannah Grace Dillon, COTA

• Surgical Technologist in Waco, TX
• Providers in Waco, TX by specialty
• Surgical Technologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 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.

Verify at the official NPI Registry.