MEDICARE: TAYLOR ROSE CONNER REGISTERED DIETITIAN

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	2338	OK

General Provider Information

NPI Number	:	1740829803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR ROSE CONNER REGISTERED DIETITIAN

Provider Business Mailing Address
First Line	:	3400 NW 19TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-3830
Country	:	US
Telephone Number	:	405-713-1125
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 NE 63RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73111-8203
Country	:	US
Telephone Number	:	405-713-1125
Fax Number	:

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

Provider Enumeration Date	:	01/06/2020
Last Update Date	:	01/06/2020

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