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General NPI Number Information
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NPI Number | 1740826494
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Entity Type | Individual
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Provider Name | SHANNON P CAMPBELL RDN, LD
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Gender | Female
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Dates
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Enumeration Date | 11/18/2019
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Last Update Date | 05/12/2021
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Provider Practice Location Address
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Address Line | 717 S HOUSTON AVE STE 400
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City | TULSA
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State | OK
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Zip | 74127-9007
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Country | US
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Telephone | 918-382-4600
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Fax | 918-382-3183
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Provider Business Mailing Address
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Address Line | 5310 E 31ST ST FL 13
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City | TULSA
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State | OK
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Zip | 74135-5018
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Country | US
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Telephone | 918-561-5701
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Fax | 918-561-1173
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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 | 133VN1201X
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Taxonomy Name | Obesity and Weight Management Nutrition Registered Dietitian
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License Number | 1864
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License Number State | OK
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