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General NPI Number Information
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NPI Number | 1952031338
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Entity Type | Organization
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Legal Business Name | THE WEIGHT LOSS AND PAIN CLINIC LLC
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Dates
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Enumeration Date | 06/16/2022
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Last Update Date | 06/16/2022
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Provider Practice Location Address
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Address Line | 1315 N WASHINGTON ST
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City | WEATHERFORD
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State | OK
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Zip | 73096-2443
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Country | US
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Telephone | 508-309-2828
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Fax |
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Provider Business Mailing Address
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Address Line | 1315 N WASHINGTON ST
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City | WEATHERFORD
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State | OK
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Zip | 73096-2443
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Country | US
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Telephone | 580-309-2828
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Fax |
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Authorized Official
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Title or Position | CERTIFIED NUTRITIONIST/OWNER
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Name | PAULA HUNNICUTT
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Credential | BCHHP
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Telephone | 580-309-2828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1004X
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Taxonomy Name | Pediatric Nutrition Registered Dietitian
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License Number |
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License Number State |
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