Active NPI
Christie Lea Coggburn, RD, LD,CSR
- Renal Nutrition Registered Dietitian
- Tahlequah, OK
National Provider Identifier
1861610503
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Renal Nutrition Registered Dietitian
- License
- LD982
- Practice address
- 100 S Bliss Ave
Tahlequah, OK 74464-2512 - Phone
- (918) 458-3178
- NPI assigned
- Apr 20, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Renal Nutrition Registered Dietitian | 133VN1005X | LD982 | OK | Primary |
Addresses
Primary practice location
100 S Bliss Ave
Tahlequah, OK 74464-2512
Mailing address
118 Eubanks
Tahlequah, OK 74464-8841
Phone (918) 431-1515
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LD982 | OK | MD | Renal Nutrition Registered Dietitian |
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": "1177027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1861610503",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "118 EUBANKS",
"city": "TAHLEQUAH",
"state": "OK",
"postal_code": "744648841",
"telephone_number": "918-431-1515"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 S BLISS AVE",
"city": "TAHLEQUAH",
"state": "OK",
"postal_code": "744642512",
"telephone_number": "918-458-3178"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COGGBURN",
"first_name": "CHRISTIE",
"middle_name": "LEA",
"name_prefix": "Ms.",
"credential": "RD, LD,CSR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133VN1005X",
"taxonomy_group": "",
"desc": "Dietitian, Registered, Nutrition, Renal",
"state": "OK",
"license": "LD982",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tahlequah, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.