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NPI Code Detail

MEDICARE: THE MOTHER ROAD DIETITIAN, LLC.

MEDICARE: THE MOTHER ROAD DIETITIAN, 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
1133V00000XRegistered Dietitian

General Provider Information

NPI Number : 1932879152
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE MOTHER ROAD DIETITIAN, LLC.
Provider Business Mailing Address
First Line : 8211 EAST REGAL PLACE STE 100
Second Line : PMB 704
City : TULSA
State : OK
Zip : 74133-7214
Country : US
Telephone Number : 918-539-0678
Fax Number : 918-273-6660
Provider Business Practice Location Address
First Line : 8211 E REGAL PL STE 100
Second Line :
City : TULSA
State : OK
Zip : 74133-7181
Country : US
Telephone Number : 918-539-0678
Fax Number : 918-273-6660
Authorized Official
Title or Position : REGISTERED DIETITIAN NUTRITIONIST
Name : KRYSTAL DUNHAM
Credential : RDN, LD
Telephone Number : 918-539-0678
Provider Enumeration Date : 09/18/2021
Last Update Date : 09/11/2025

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Directions to “THE MOTHER ROAD DIETITIAN, LLC. ” Practice Location

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