Healthcare Provider Details

I. General information

NPI: 1508359118
Provider Name (Legal Business Name): JAMIE MCCASLIN HARRY RD, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2018
Last Update Date: 06/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 S LEWIS AVE
TULSA OK
74104-5733
US

IV. Provider business mailing address

995 TUSKAWILLA RD
WINTER SPRINGS FL
32708-4401
US

V. Phone/Fax

Practice location:
  • Phone: 918-749-9077
  • Fax:
Mailing address:
  • Phone: 407-637-0273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number16436
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: