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General NPI Number Information
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NPI Number | 1659280501
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Entity Type | Organization
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Legal Business Name | PERSONALIZED LIFESTYLE NUTRITION, LLC
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Dates
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Enumeration Date | 09/04/2026
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Last Update Date | 09/04/2026
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Provider Practice Location Address
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Address Line | 1125 N PORTER AVE STE 305
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City | NORMAN
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State | OK
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Zip | 73071-6446
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Country | US
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Telephone | 405-245-9475
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Fax |
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Provider Business Mailing Address
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Address Line | 4232 HACKNEY WICK RD
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City | NORMAN
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State | OK
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Zip | 73072-9790
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | TAMRA KEYS WINSTON
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Credential |
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Telephone | 281-790-0188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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