Healthcare Provider Details

I. General information

NPI: 1851613236
Provider Name (Legal Business Name): JESSICA L. STAUFFER M.S., R.D., L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2010
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9215 S FULTON AVE
TULSA OK
74137-4018
US

IV. Provider business mailing address

9215 S FULTON AVE
TULSA OK
74137-4018
US

V. Phone/Fax

Practice location:
  • Phone: 405-747-1720
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberDT80815
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: