Kelly M Knoebel, RDN
Individual provider Active NPI Registered Dietitian · Oneida, WI
NPI 1962089029 · NPPES record last updated Aug 23, 2021
Key facts
- NPI
- 1962089029
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- 3627 (WI)
- Practice address
- 525 Airport Dr
Oneida, WI 54155-9035 - Phone
- (920) 869-2711
- Fax
- (920) 869-4909
- NPI assigned
- Mar 25, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210409001500 | WI | Practitioner - Registered Dietitian Or Nutrition Professional | 2264840313 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Oneida Nation | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 3627 | WI | Yes |
Addresses
Primary practice location
525 Airport Dr
Oneida, WI 54155-9035
Mailing address
PO Box 365
Oneida, WI 54155-0365
Phone (920) 869-2711
Other providers in Oneida, WI
- Gabriella James
- Kim E Javens
- Tina Jorgensen
- Susan L Katuin
- Jay Kelly Kennard
- Dawn Krines
- Heather J Lallaman
- Mary C Lamers
- Kalyn Elizabeth Leege
- Heidi McCann
All providers in Oneida, WI · Registered Dietitian in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 23, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.