Individual provider Active NPI

Kelsey Riebel

  • Physician Assistant
  • Bartlesville, OK
National Provider Identifier
1730631912
Registry record updated Feb 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2756 Issued in OK
Practice address
3500 E Frank Phillips Blvd
Bartlesville, OK 74006-2411
Phone
(918) 333-7200
NPI assigned
Nov 3, 2016
Last updated
Feb 8, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2756 OK Primary

Addresses

Primary practice location

3500 E Frank Phillips Blvd
Bartlesville, OK 74006-2411

Mailing address

1705 E 19TH St
Ste 302
Tulsa, OK 74104-5410
Phone (918) 748-7585

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180813002923 TX Practitioner - Physician Assistant 8628352309

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2756OKMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Osage Nation Si-Si a-Pe-Txa CurrentSince Jun 25, 2018 Accepting new patients
St. John Physicians, Inc. Past Accepting new patients

Locations

715 Grandview Ave
Pawhuska, OK 74056
Phone (918) 287-4491

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1478131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486512000000",
    "number": "1730631912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1705 E 19TH ST",
            "address_2": "STE 302",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741045410",
            "telephone_number": "918-748-7585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 E FRANK PHILLIPS BLVD",
            "city": "BARTLESVILLE",
            "state": "OK",
            "postal_code": "740062411",
            "telephone_number": "918-333-7200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIEBEL",
        "first_name": "KELSEY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-03",
        "last_updated": "2017-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "2756",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bartlesville, OK

Sources for this page

Verify at the official NPI Registry.