Healthcare Provider Details

I. General information

NPI: 1730165291
Provider Name (Legal Business Name): THERESA DIANNE OSTEEN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 ANDREWS AVENUE LYSTER ARMY HEALTH CLINIC
FORT RUCKER AL
36362
US

IV. Provider business mailing address

301 ANDREWS AVENUE LYSTER ARMY HEALTH CLINIC
FORT RUCKER AL
36362
US

V. Phone/Fax

Practice location:
  • Phone: 334-255-7387
  • Fax: 334-255-7716
Mailing address:
  • Phone: 334-255-7387
  • Fax: 334-255-7716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1714
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: