MISS KELLY KATHLEEN OTOOLE WOOD RDN, LDN
NPI 1790288124
Dietitian, Registered in Boise, ID

Q: What is Kelly Otoole Wood's NPI number?

The NPI number for Kelly Otoole Wood is 1790288124. It was assigned to this individual provider in the NPPES registry on March 12, 2018. The provider is also known as Miss Kelly Kathleen O'toole Rd, Ld.

Q: What is Kelly Otoole Wood's specialty?

The primary specialty registered for this NPI is Dietitian, Registered with taxonomy code 133V00000X.

Q: When was this NPI record last updated?

The NPPES record for Kelly Otoole Wood was last updated on November 28, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since March 12, 2018

6126 W STATE ST, BOISE, ID 83703(208) 407-8921(208) 694-7837 Get Directions Write a Review

NPPES record last updated: November 28, 2023. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Jul 16, 2022, Apr 24, 2018, Mar 12, 2018 (3 updates tracked since 2018).

On this page

About Miss Kelly Kathleen Otoole Wood Rdn, Ldn NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MISS KELLY KATHLEEN OTOOLE WOOD RDN, LDN (NPI 1790288124) is an individual dietitian, registered in Boise, Idaho, licensed in Idaho (D-460) and active in the NPI registry since March 2018. She maintains a secondary practice location in Boise.

NPPES Registry Identity

NPI1790288124

Entity TypeIndividualFemale

Primary Taxonomy133V00000X

Provider Legal NameMISS KELLY KATHLEEN OTOOLE WOODCredential: RDN, LDN

Location Address6126 W STATE STBoise, ID 83703-2741

Mailing Address13447 N 2nd AveBoise, ID 83714-9409 · (208) 407-8921 · Fax (208) 694-7837

Phone(208) 407-8921

Fax(208) 694-7837

Sole ProprietorYes

Enumeration DateMarch 12, 2018

Last NPPES UpdateNovember 28, 20233 updates tracked since enumeration

NPPES CertifiedNovember 28, 2023

✔ NPI 1790288124 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDietitian, RegisteredDietary & Nutritional Service Providers

Taxonomy Code133V00000X

License✔ Licensed in ID · D-460

Definition

A Registered Dietitian (RD)/Registered Dietitian Nutritionist (RDN) is an individual uniquely trained in the science of nutrition and practice of dietetics to design and provide medical nutrition therapy (MNT) and other evidence-based applications of the Nutrition Care Process (NCP) that exemplify the profession's systematic approach to providing high quality nutrition care. Registered dietitians provide MNT for the purpose of disease prevention or management, or to treat or rehabilitate an illness, injury, or condition, with the use of specific, indicated physical and cognitive nutrition care services comprised of one or more of the following aspects of the NCP: nutrition assessment/reassessment, nutrition diagnosis, nutrition intervention (e.g., nutrition counseling, therapeutic diet ordering, and nutrition education) and nutrition monitoring and evaluation.

6126 W STATE ST, Boise, ID 83703

Open in Google Maps ↗

Other Names 1

Former Name (1)Miss Kelly Kathleen O'toole Rd, Ld

Secondary Practice Location 1

Location 113447 N 2nd AveBoise, ID 83714-9409 · Phone (208) 407-8921

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Moda Health Plan, Inc., PacificSource Health Plans, Providence Health Plan and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Miss Kelly Kathleen Otoole Wood Rdn, Ldn is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Billing Reassignment

Medicare enrollment records show Kelly Otoole Wood reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Idaho Nutrition Associates, LLC

4.5 mi

Dietitian, Registered

1013 E WINDING CREEK DR STE 102
Eagle, ID 83616

Reassigned Medicare billing, Idaho enrollment
3 clinicians in this Medicare group

NPI 1568992105 (208) 250-5657

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LEANN W VATERLAUS LMSW

Counselor (Mental Health)

6126 W STATE ST
BOISE, ID 83703

Ada County (208) 391-5941

ELIZABETH BADER-HELLSTROM LMSW

Social Worker

6126 W STATE ST, SUITE 310
BOISE, ID 83703

Ada County (208) 994-9852

MS. MARY THERESA PIERCE LCSW

Social Worker (Clinical)

6126 W STATE ST
BOISE, ID 83703

Ada County (208) 919-5067

MR. DAVID BUCH LCSW

Counselor (Mental Health)

6126 W STATE ST
BOISE, ID 83703

Ada County (208) 806-1900

THRIVE WITH CBT - A THERAPY PLACE

Clinic/Center (Mental Health (Including Community Mental Health Center))

6126 W STATE ST
BOISE, ID 83703

Ada County (208) 477-1202

MEGAN LINZ LCSW

Social Worker (Clinical)

6126 W STATE ST, SUITE 106
BOISE, ID 83703

Ada County (208) 695-3014

KRISTIN BEAUFORT LMSW

Social Worker

6126 W STATE ST
BOISE, ID 83703

Ada County (208) 943-7249

PAMELA HARRIS LPC

Counselor (Professional)

6126 W STATE ST
BOISE, ID 83703

Ada County (208) 602-2660

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelly Otoole Wood's NPI number?

The NPI number for Kelly Otoole Wood is 1790288124. It was assigned to this individual provider in the NPPES registry on March 12, 2018. The provider is also known as Miss Kelly Kathleen O'toole Rd, Ld.

Where is Kelly Otoole Wood located?

Kelly Otoole Wood practices at 6126 W State St, Boise, ID 83703. The listed phone number is (208) 407-8921.

What is Kelly Otoole Wood's specialty?

The primary specialty registered for this NPI is Dietitian, Registered with taxonomy code 133V00000X.

Is Kelly Otoole Wood enrolled in Medicare?

Yes. Kelly Otoole Wood is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Kelly Otoole Wood's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kelly Otoole Wood reassigns Medicare benefits to Idaho Nutrition Associates, LLC (Eagle, ID). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kelly Otoole Wood's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Kelly Otoole Wood accept?

Health plans from Moda Health Plan, Inc., PacificSource Health Plans, Providence Health Plan and Select Health list Kelly Otoole Wood as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kelly Otoole Wood was last updated on November 28, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.