=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639898638
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDSEY OVERSTREET RDN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2022
-----------------------------------------------------
Last Update Date | 08/23/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 115 W 3RD ST STE 800
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74103-3411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-585-3045
-----------------------------------------------------
Fax | 918-585-3047
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 115 W 3RD ST STE 800
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74103-3411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-585-3045
-----------------------------------------------------
Fax | 918-585-3047
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------