Healthcare Provider Details

I. General information

NPI: 1548644388
Provider Name (Legal Business Name): LINDA YAUK MS, RD/LD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2015
Last Update Date: 07/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S 3RD ST
ENID OK
73701-5737
US

IV. Provider business mailing address

401 S 3RD ST
ENID OK
73701-5737
US

V. Phone/Fax

Practice location:
  • Phone: 580-249-4104
  • Fax: 580-249-4195
Mailing address:
  • Phone: 580-249-4104
  • Fax: 580-249-4195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD707
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: