MEDICARE: ALLIED NUTRITION CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1033865944
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIED NUTRITION CARE LLC

Provider Business Mailing Address
First Line	:	1417 SW 129TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-6918
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1417 SW 129TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-6918
Country	:	US
Telephone Number	:	405-209-5076
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ASHLEY GIDDENS
Credential	:	RD
Telephone Number	:	405-209-5076

Provider Enumeration Date	:	03/01/2022
Last Update Date	:	03/04/2022

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