Healthcare Provider Details

I. General information

NPI: 1083613152
Provider Name (Legal Business Name): RUTH ANN GIVENS LICENSED DIETITIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 2 BOX 14
ARNETT OK
73832-9410
US

IV. Provider business mailing address

RR 2 BOX 14
ARNETT OK
73832-9410
US

V. Phone/Fax

Practice location:
  • Phone: 580-885-7873
  • Fax: 580-885-7873
Mailing address:
  • Phone: 580-885-7873
  • Fax: 580-885-7873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number963
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: