Active NPI
Tracie Kennon Mathis, RD/LD IBCLC
- Registered Dietitian
- Tulsa, OK
National Provider Identifier
1720267651
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- LD932
- Practice address
- 6161 S Yale Ave
Tulsa, OK 74136-1902 - Phone
- (918) 230-6409
- NPI assigned
- Oct 27, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | LD932 | OK | Primary |
Addresses
Primary practice location
6161 S Yale Ave
Tulsa, OK 74136-1902
Mailing address
8710 S 71St East Ave
Tulsa, OK 74133-5053
Phone (918) 494-6455
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 |
|---|---|---|---|
| LD932 | OK | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193443200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1643155200000",
"number": "1720267651",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8710 S 71ST EAST AVE",
"city": "TULSA",
"state": "OK",
"postal_code": "741335053",
"telephone_number": "918-494-6455"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6161 S YALE AVE",
"city": "TULSA",
"state": "OK",
"postal_code": "741361902",
"telephone_number": "918-230-6409"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATHIS",
"first_name": "TRACIE",
"middle_name": "KENNON",
"credential": "RD/LD IBCLC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-10-27",
"last_updated": "2022-01-26",
"certification_date": "2022-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "OK",
"license": "LD932",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tulsa, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.