Healthcare Provider Details

I. General information

NPI: 1962863704
Provider Name (Legal Business Name): FELICIA SIMPSON MPPD, RD/LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FELICIA WATKINS

II. Dates (important events)

Enumeration Date: 03/07/2016
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S BLISS AVE
TAHLEQUAH OK
74464-2512
US

IV. Provider business mailing address

17056 W 782 RD
TAHLEQUAH OK
74464-7379
US

V. Phone/Fax

Practice location:
  • Phone: 918-458-3100
  • Fax:
Mailing address:
  • Phone: 918-822-0245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: