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NPI Code Detail

MEDICARE: KRYSTAL DUNHAM MS, RDN, LD

MEDICARE: KRYSTAL DUNHAM 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
1133V00000XRegistered Dietitian2609AR
2133V00000XRegistered DietitianLD2630OK

General Provider Information

NPI Number : 1609546829
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRYSTAL DUNHAM MS, RDN, LD
Provider Business Mailing Address
First Line : 8211 E REGAL PL STE 100
Second Line : PMB 704
City : TULSA
State : OK
Zip : 74133-7181
Country : US
Telephone Number : 918-539-0678
Fax Number : 918-273-6660
Provider Business Practice Location Address
First Line : 8211 E REGAL PL STE 100
Second Line :
City : TULSA
State : OK
Zip : 74133-7181
Country : US
Telephone Number : 918-539-0678
Fax Number : 918-273-6660
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/18/2021
Last Update Date : 06/26/2025

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