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General NPI Number Information
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NPI Number | 1790015980
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Entity Type | Individual
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Provider Name | KRISTIE ANN PURDY MS, RD/LD
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Gender | Female
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Dates
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Enumeration Date | 01/11/2010
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Last Update Date | 05/13/2011
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Provider Practice Location Address
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Address Line | RR 1 BOX 3060
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City | CLINTON
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State | OK
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Zip | 73601-9303
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Country | US
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Telephone | 580-331-3458
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Fax | 580-323-2579
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Provider Business Mailing Address
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Address Line | RR 1 BOX 3060
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City | CLINTON
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State | OK
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Zip | 73601-9303
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Country | US
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Telephone | 580-331-3458
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Fax | 580-323-2579
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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 | 1634
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License Number State | OK
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