Active NPI
Kelly Kathleen Otoole Wood, RDN, LDN
- Registered Dietitian
- Boise, ID
National Provider Identifier
1790288124
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- D-460
- Practice address
- 6126 W State St
Boise, ID 83703-2741 - Phone
- (208) 407-8921
- Fax
- (208) 694-7837
- NPI assigned
- Mar 12, 2018
- 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 | D-460 | ID | Primary |
Addresses
Primary practice location
6126 W State St
Boise, ID 83703-2741
Mailing address
13447 N 2ND Ave
Boise, ID 83714-9409
Phone (208) 407-8921
Other practice location 1
13447 N 2nd Ave
Boise, ID 83714-9409
Phone (208) 407-8921
Other names 1
- Miss Kelly Kathleen O'Toole
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D-460 | ID | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Idaho Nutrition Associates, LLC | Dietitian, Registered | Current | Accepting new patients |
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
Locations
13900 W Wainwright Dr
Ste 102
Boise, ID 83713
Phone (208) 433-9424
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1520812800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701129600000",
"number": "1790288124",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13447 N 2ND AVE",
"city": "BOISE",
"state": "ID",
"postal_code": "837149409",
"telephone_number": "208-407-8921",
"fax_number": "208-694-7837"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6126 W STATE ST",
"city": "BOISE",
"state": "ID",
"postal_code": "837032741",
"telephone_number": "208-407-8921",
"fax_number": "208-694-7837"
}
],
"practiceLocations": [
{
"address_1": "13447 N 2nd Ave",
"address_purpose": "LOCATION",
"city": "Boise",
"state": "ID",
"postal_code": "837149409",
"country_code": "US",
"telephone_number": "208-407-8921",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "OTOOLE WOOD",
"first_name": "KELLY",
"middle_name": "KATHLEEN",
"name_prefix": "Miss",
"credential": "RDN, LDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-03-12",
"last_updated": "2023-11-28",
"certification_date": "2023-11-28",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "ID",
"license": "D-460",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KELLY",
"last_name": "O'TOOLE",
"middle_name": "KATHLEEN",
"prefix": "MISS",
"credential": "RD, LD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2023; 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.