Healthcare Provider Details

I. General information

NPI: 1902299639
Provider Name (Legal Business Name): NUTRITION SPECIALISTS OF NORTHEASTERN OKLAHOMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2015
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4230 E 76TH ST
TULSA OK
74136-8115
US

IV. Provider business mailing address

4230 E 76TH ST
TULSA OK
74136-8115
US

V. Phone/Fax

Practice location:
  • Phone: 918-272-4207
  • Fax: 866-296-1005
Mailing address:
  • Phone: 918-272-4207
  • Fax: 866-296-1005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1488
License Number StateOK

VIII. Authorized Official

Name: VIRGINIA SOMERVILLE
Title or Position: PRESIDENT
Credential: RDN/LD
Phone: 918-272-4207