Healthcare Provider Details

I. General information

NPI: 1609283191
Provider Name (Legal Business Name): SHELLEY FEHRENBACH FRITCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHELLEY CHRISTINE FEHRENBACH RD/LD

II. Dates (important events)

Enumeration Date: 07/16/2014
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CHILDRENS AVE # 4D
OKLAHOMA CITY OK
73104-4637
US

IV. Provider business mailing address

PO BOX 269025
OKLAHOMA CITY OK
73126-9025
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-8001
  • Fax: 405-271-4995
Mailing address:
  • Phone: 405-271-1500
  • Fax: 405-271-4995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1758
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: