Provider Demographics
NPI:1770099657
Name:TANGNEY, KELSEY MICHELLE (RD/LD)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:MICHELLE
Last Name:TANGNEY
Suffix:
Gender:F
Credentials:RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 NW 58TH ST STE 910-W
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4707
Mailing Address - Country:US
Mailing Address - Phone:405-885-0270
Mailing Address - Fax:405-300-4492
Practice Address - Street 1:3555 NW 58TH ST STE 910-W
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4707
Practice Address - Country:US
Practice Address - Phone:405-885-0270
Practice Address - Fax:405-300-4492
Is Sole Proprietor?:No
Enumeration Date:2017-12-14
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2172133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered