Healthcare Provider Details

I. General information

NPI: 1700024114
Provider Name (Legal Business Name): KATHY LUANN ALFORD-DURBIN RD/LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHY LUANN DURBIN RD/LD

II. Dates (important events)

Enumeration Date: 01/23/2009
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W FORREST AVE
EUFAULA OK
74432-3249
US

IV. Provider business mailing address

800 W FORREST AVE
EUFAULA OK
74432-3249
US

V. Phone/Fax

Practice location:
  • Phone: 918-689-2540
  • Fax: 918-618-2164
Mailing address:
  • Phone: 918-689-2540
  • Fax: 918-618-2164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number800
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: