Healthcare Provider Details

I. General information

NPI: 1659593168
Provider Name (Legal Business Name): BANISTER & ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10914 HEFNER POINTE DR STE 304
OKLAHOMA CITY OK
73120-5068
US

IV. Provider business mailing address

10914 HEFNER POINTE DR STE 304
OKLAHOMA CITY OK
73120-5068
US

V. Phone/Fax

Practice location:
  • Phone: 405-755-7561
  • Fax: 405-755-7615
Mailing address:
  • Phone: 405-755-7561
  • Fax: 405-755-7615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number251
License Number StateOK

VIII. Authorized Official

Name: CAROL BANISTER
Title or Position: OWNERMANAGER
Credential: RDLD
Phone: 405-755-7561