Active NPI
Kelly Ann Demers, RD
- Registered Dietitian
- Oklahoma City, OK
National Provider Identifier
1992273346
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 3084
- Practice address
- 10600 S Pennsylvania Ave Ste 16
Oklahoma City, OK 73170-4257 - Phone
- (405) 960-3120
- NPI assigned
- Nov 4, 2018
- 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 4433 | MN | |
| Registered Dietitian | 133V00000X | D-10195067 | OR | |
| Registered Dietitian | 133V00000X | 0740134470 | VT | |
| Registered Dietitian | 133V00000X | 3084 | OK | Primary |
Addresses
Primary practice location
10600 S Pennsylvania Ave Ste 16
Oklahoma City, OK 73170-4257
Mailing address
17 Oak St Apt 5
Brattleboro, VT 05301-6715
Phone (518) 545-0128
Other names 1
- Kelly Ann Smith
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D-10195067 | OR | MD | Registered Dietitian |
| 0740134470 | VT | MD | Registered Dietitian |
| 3084 | OK | MD | Hospitalist Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
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": "1541289600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1741564800000",
"number": "1992273346",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17 OAK ST APT 5",
"city": "BRATTLEBORO",
"state": "VT",
"postal_code": "053016715",
"telephone_number": "518-545-0128"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10600 S PENNSYLVANIA AVE STE 16",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731704257",
"telephone_number": "405-960-3120"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEMERS",
"first_name": "KELLY",
"middle_name": "ANN",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-11-04",
"last_updated": "2025-03-10",
"certification_date": "2025-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MN",
"license": "4433",
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "OR",
"license": "D-10195067",
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "VT",
"license": "0740134470",
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "OK",
"license": "3084",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KELLY",
"last_name": "SMITH",
"middle_name": "ANN",
"credential": "RD, LD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.