Healthcare Provider Details

I. General information

NPI: 1336161728
Provider Name (Legal Business Name): KAREN RENEE RODGERS L.D./R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS KAREN RENEE MELTON

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S PEORIA AVE
TULSA OK
74120-3820
US

IV. Provider business mailing address

550 S PEORIA AVE
TULSA OK
74120-3820
US

V. Phone/Fax

Practice location:
  • Phone: 918-588-1900
  • Fax: 918-582-6405
Mailing address:
  • Phone: 918-588-1900
  • Fax: 918-582-6405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number1078
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number863590
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: