Individual provider Active NPI

Kelsey Michelle Tangney, RD/LD

  • Registered Dietitian
  • Oklahoma City, OK
National Provider Identifier
1770099657
Registry record updated Sep 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
2172 Issued in OK
Practice address
3555 NW 58TH St Ste 910-W
Oklahoma City, OK 73112-4707
Phone
(405) 885-0270
Fax
(405) 300-4492
NPI assigned
Dec 14, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 2172 OK Primary

Addresses

Primary practice location

3555 NW 58TH St Ste 910-W
Oklahoma City, OK 73112-4707

Mailing address

3555 NW 58TH St Ste 910-W
Oklahoma City, OK 73112-4707
Phone (405) 885-0270

Other practice location 1

4913 W Reno Ave
Oklahoma City, OK 73127-6339
Phone (405) 948-4900 ext. 607

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220509002423 OK Practitioner - Registered Dietitian Or Nutrition Professional 6608274725 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
2172OKMDRegistered Dietitian
2272OKMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Well Rooted Health and Nutrition CurrentSince Apr 20, 2022 Accepting new patients

Locations

3555 NW 58th St
Ste 910W
Oklahoma City, OK 73112
Phone (405) 653-9161

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": "1513209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663286400000",
    "number": "1770099657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3555 NW 58TH ST STE 910-W",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731124707",
            "telephone_number": "405-885-0270",
            "fax_number": "405-300-4492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3555 NW 58TH ST STE 910-W",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731124707",
            "telephone_number": "405-885-0270",
            "fax_number": "405-300-4492"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4913 W Reno Ave",
            "address_purpose": "LOCATION",
            "city": "Oklahoma City",
            "state": "OK",
            "postal_code": "731276339",
            "country_code": "US",
            "telephone_number": "405-948-4900 x607",
            "fax_number": "405-948-4933",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TANGNEY",
        "first_name": "KELSEY",
        "middle_name": "MICHELLE",
        "credential": "RD/LD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-14",
        "last_updated": "2022-09-16",
        "certification_date": "2022-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "OK",
            "license": "2172",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.