Healthcare Provider Details

I. General information

NPI: 1346473816
Provider Name (Legal Business Name): JENNIFER LEIGH WITHERSPOON MS, RD, CSO, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2009
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 NE 10TH ST STE 6049
OKLAHOMA CITY OK
73104-5418
US

IV. Provider business mailing address

800 NE 10TH ST STE 6049
OKLAHOMA CITY OK
73104-5418
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1301X
TaxonomyOncology Nutrition Registered Dietitian
License Number1435
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1435
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: