Healthcare Provider Details

I. General information

NPI: 1326640285
Provider Name (Legal Business Name): CARI HORN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2020
Last Update Date: 11/14/2020
Certification Date: 11/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3524 NW 56TH ST
OKLAHOMA CITY OK
73112-4518
US

IV. Provider business mailing address

8808 NW 72ND ST
OKLAHOMA CITY OK
73132-3791
US

V. Phone/Fax

Practice location:
  • Phone: 405-606-6937
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number2104
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: