Healthcare Provider Details

I. General information

NPI: 1972991883
Provider Name (Legal Business Name): BAILEY HOLDEN MS, RD/LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2014
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 NW 72ND ST
WARR ACRES OK
73132-5931
US

IV. Provider business mailing address

4109 NW 21ST ST
OKLAHOMA CITY OK
73107-2607
US

V. Phone/Fax

Practice location:
  • Phone: 918-914-0901
  • Fax:
Mailing address:
  • Phone: 918-914-0901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number2045
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86012968
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: