Kellie R Bryant
Individual provider Active NPI Registered Dietitian · Pawnee, OK
NPI 1649467424 · NPPES record last updated Sep 26, 2007
Key facts
- NPI
- 1649467424
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- 805 (OK)
- Practice address
- 1201 Heritage Cir
Pawnee, OK 74058-3744 - Phone
- (918) 762-6638
- NPI assigned
- Sep 26, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Registered Dietitian Or Nutrition Professional
- Education
- Other, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Pawnee Indian Health Center
Practice addresses (Care Compare)
1201 Heritage Cir
Pawnee, OK 74058-3744
Phone (918) 762-2517
1201 Heritage Circle
Pawnee, OK 74058-3744
1201 Heritage Circle Dr
Pawnee, OK 74058-3744
Hospital & facility affiliations
- Lawton Indian Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050519000409 | TX | Practitioner - Registered Dietitian Or Nutrition Professional | 5890736821 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pawnee IHS Pharmacy | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 805 | OK | Yes |
Addresses
Primary practice location
1201 Heritage Cir
Pawnee, OK 74058-3744
Mailing address
1201 Heritage Cir
Pawnee, OK 74058-3744
Phone (918) 762-6638
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8HD668 | Other | OK | MEDICARE PROVIDER NUMBER |
Other providers in Pawnee, OK
- April Renee Bohnstedt
- Logan Bone
- Boss Medical, LLC
- Gabrielle Sue Bottger
- Krista L Bright
- Kristi Marie Bryant
- James Robert Burnham IX
- Cah Acquisition Company 12 LLC
- Laci Jolee Campbell
- CHI Inc
All providers in Pawnee, OK · Registered Dietitian in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 26, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.