Healthcare Provider Details

I. General information

NPI: 1346237815
Provider Name (Legal Business Name): STATE OF OK, BOARD OF REGENTS, UNIVERSITY OF OK HEALTH SCIENCES CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N PHILLIPS AVE COAH NUTRITION COUNSELING CLINIC
OKLAHOMA CITY OK
73104-4619
US

IV. Provider business mailing address

DEPARTMENT OF NUTRITIONAL SCIENCES PO BOX 26901, CHB 469
OKLAHOMA CITY OK
73190-0001
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-2113
  • Fax: 405-271-1560
Mailing address:
  • Phone: 405-271-2113
  • Fax: 405-271-1560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENIELLE SUE GREENLEE
Title or Position: ASSOC DEAN FOR FIN, ALLIED HEALTH
Credential: BBA, MPH
Phone: 405-271-2288