Healthcare Provider Details

I. General information

NPI: 1699941542
Provider Name (Legal Business Name): PATRICIA LOU PRATHER RD/LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PATSY PRATHER RD/LD

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 1 BOX 115 12373 N 1740 RD
ERICK OK
73645-9736
US

IV. Provider business mailing address

RR 1 BOX 115 12373 N 1740 RD
ERICK OK
73645-9736
US

V. Phone/Fax

Practice location:
  • Phone: 580-526-3024
  • Fax:
Mailing address:
  • Phone: 580-526-3024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD43
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: