Healthcare Provider Details

I. General information

NPI: 1518515956
Provider Name (Legal Business Name): WELL ROOTED HEALTH AND NUTRITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 08/31/2025
Certification Date: 08/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16308 IRONSTONE PLACE
EDMOND OK
73013
US

IV. Provider business mailing address

16308 IRONSTONE PLACE
EDMOND OK
73013-9730
US

V. Phone/Fax

Practice location:
  • Phone: 405-885-0270
  • Fax: 405-300-4492
Mailing address:
  • Phone: 405-837-7003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: UMO CALLINS
Title or Position: OWNER
Credential: MS, RD/LD, CSSD, CPT
Phone: 405-837-7003