MEDICARE: MS. KIMBERLY DAWN DAVIS M.S., R.D.

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	LD1096	OK

General Provider Information

NPI Number	:	1316002405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLY DAWN DAVIS M.S., R.D.

Provider Business Mailing Address
First Line	:	1225 W MAIN ST
Second Line	:	SUITE 102
City	:	NORMAN
State	:	OK
Zip	:	73069-6824
Country	:	US
Telephone Number	:	405-292-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1225 W MAIN ST
Second Line	:	SUITE 102
City	:	NORMAN
State	:	OK
Zip	:	73069-6824
Country	:	US
Telephone Number	:	405-292-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	07/08/2007

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