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NPI Code Detail

MEDICARE: MRS. JUSSARA MARISA LITTLE RD, LDN

MEDICARE: MRS. JUSSARA MARISA LITTLE RD, LDN
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
1133V00000XRegistered DietitianND6564FL
2133V00000XRegistered DietitianLD2121OK

General Provider Information

NPI Number : 1912367681
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JUSSARA MARISA LITTLE RD, LDN
Provider Business Mailing Address
First Line : 711 STANTON L YOUNG BLVD STE 430A
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73104-5022
Country : US
Telephone Number : 405-271-8001
Fax Number : 405-271-5439
Provider Business Practice Location Address
First Line : 711 STANTON L YOUNG BLVD STE 430A
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73104-5022
Country : US
Telephone Number : 405-271-8001
Fax Number : 405-271-5439
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/24/2016
Last Update Date : 05/29/2024

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