Healthcare Provider Details

I. General information

NPI: 1780605030
Provider Name (Legal Business Name): GABRIELLE DAWN TAYLOR R.D./L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS GABRIELLE DAWN KETTER

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6655 S YALE AVE
TULSA OK
74136-3326
US

IV. Provider business mailing address

PO BOX 707001
TULSA OK
74170-7001
US

V. Phone/Fax

Practice location:
  • Phone: 918-491-3700
  • Fax: 918-481-4063
Mailing address:
  • Phone: 888-247-0125
  • Fax: 918-502-8210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1395
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: