Healthcare Provider Details

I. General information

NPI: 1770099657
Provider Name (Legal Business Name): KELSEY MICHELLE TANGNEY RD/LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2017
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 NW 58TH ST STE 910-W
OKLAHOMA CITY OK
73112-4707
US

IV. Provider business mailing address

3555 NW 58TH ST STE 910-W
OKLAHOMA CITY OK
73112-4707
US

V. Phone/Fax

Practice location:
  • Phone: 405-885-0270
  • Fax: 405-300-4492
Mailing address:
  • Phone: 405-885-0270
  • Fax: 405-300-4492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2172
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: