NPIMap

Organization Active NPI

Nutrition Specialists of Northeastern Oklahoma

  • Registered Dietitian
  • Tulsa, OK
National Provider Identifier
1902299639
Registry record updated Sep 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
1488 Issued in OK
Legal business name
NUTRITION SPECIALISTS OF NORTHEASTERN OKLAHOMA
Practice address
4230 E 76TH St
Tulsa, OK 74136-8115
Phone
(918) 272-4207
Fax
(866) 296-1005
NPI assigned
Mar 4, 2015
Last updated
Sep 4, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2026

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

Authorized official

Name
Virginia Somerville, RDN/LD
Title
President
Phone
(918) 272-4207

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 1488 OK Primary

Addresses

Primary practice location

4230 E 76TH St
Tulsa, OK 74136-8115

Mailing address

4230 E 76TH St
Tulsa, OK 74136-8115
Phone (918) 272-4207

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201214000080 OK Part B Supplier - Clinic/Group Practice 5991117129 Receives reassigned benefits from 6 practitioners
Practice locations: Owasso, OK

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1425427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788480000000",
    "number": "1902299639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4230 E 76TH ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741368115",
            "telephone_number": "918-272-4207",
            "fax_number": "866-296-1005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4230 E 76TH ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741368115",
            "telephone_number": "918-272-4207",
            "fax_number": "866-296-1005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NUTRITION SPECIALISTS OF NORTHEASTERN OKLAHOMA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-04",
        "last_updated": "2026-09-04",
        "certification_date": "2026-09-04",
        "status": "A",
        "authorized_official_last_name": "SOMERVILLE",
        "authorized_official_first_name": "VIRGINIA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "918-272-4207",
        "authorized_official_credential": "RDN/LD"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "OK",
            "license": "1488",
            "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 Sep 4, 2026; 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.