Healthcare Provider Details

I. General information

NPI: 1013245638
Provider Name (Legal Business Name): MELISSA KIRBY HEUER RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA SUE KIRBY

II. Dates (important events)

Enumeration Date: 11/19/2009
Last Update Date: 11/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 2 BOX 246
STROUD OK
74079-9652
US

IV. Provider business mailing address

RR 2 BOX 246
STROUD OK
74079-9652
US

V. Phone/Fax

Practice location:
  • Phone: 918-968-9531
  • Fax: 918-968-1532
Mailing address:
  • Phone: 918-968-9531
  • Fax: 918-968-1532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1682
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: