Healthcare Provider Details

I. General information

NPI: 1912414947
Provider Name (Legal Business Name): KELSEY ELIZABETH WATKINS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELSEY ELIZABETH SCHMITZ

II. Dates (important events)

Enumeration Date: 12/28/2017
Last Update Date: 12/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3261 24TH AVE NW STE 101
NORMAN OK
73069-6666
US

IV. Provider business mailing address

2308 CARLTON WAY
OKLAHOMA CITY OK
73120-3507
US

V. Phone/Fax

Practice location:
  • Phone: 405-364-6432
  • Fax:
Mailing address:
  • Phone: 918-520-9491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2289
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: