MEDICARE: EMILY SUE HICKS MS, RDN, LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	2080	OK

General Provider Information

NPI Number	:	1376032722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY SUE HICKS MS, RDN, LD

Provider Business Mailing Address
First Line	:	1500 STEEPLE CHASE ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73131-1222
Country	:	US
Telephone Number	:	405-606-1086
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 STEEPLE CHASE ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73131-1222
Country	:	US
Telephone Number	:	405-606-1086
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2018
Last Update Date	:	05/01/2018

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