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General NPI Number Information
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NPI Number | 1275650475
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Entity Type | Individual
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Provider Name | PATRICIA RENAE GASKINS-CLARK MS, RD, LD
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Gender | Female
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 901 N PORTER AVE FOOD & NUTRITION SERVICES
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City | NORMAN
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State | OK
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Zip | 73071-6404
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Country | US
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Telephone | 405-307-2130
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Fax | 405-307-2120
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Provider Business Mailing Address
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Address Line | 2716 SW 123RD CT
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City | OKLAHOMA CITY
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State | OK
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Zip | 73170-4739
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Country | US
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Telephone | 405-691-0444
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | LD517
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License Number State | OK
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