Active NPI
Tracey Long, MPH, RDN
- Registered Dietitian
- Overland Park, KS
National Provider Identifier
1962958587
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86068129
- Practice address
- 6824 W 72ND Ter
Overland Park, KS 66204-1920 - Phone
- (303) 588-9701
- NPI assigned
- Sep 1, 2016
- 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 | 86068129 | KS | Primary |
Addresses
Primary practice location
6824 W 72ND Ter
Overland Park, KS 66204-1920
Mailing address
6824 W 72ND Ter
Overland Park, KS 66204-1920
Phone (303) 588-9701
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 1, 2017 through Oct 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86068129 | KS | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1472688000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1474848000000",
"number": "1962958587",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6824 W 72ND TER",
"city": "OVERLAND PARK",
"state": "KS",
"postal_code": "662041920",
"telephone_number": "303-588-9701"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6824 W 72ND TER",
"city": "OVERLAND PARK",
"state": "KS",
"postal_code": "662041920",
"telephone_number": "303-588-9701"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LONG",
"first_name": "TRACEY",
"credential": "MPH, RDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-09-01",
"last_updated": "2016-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "KS",
"license": "86068129",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Overland Park, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.