Individual
MS. JESSICA TILLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
8505 N 129TH EAST AVE, OWASSO, OK 74055-7168
(918) 376-2529
(918) 376-2548
Mailing address
8505 N 129TH EAST AVE, OWASSO, OK 74055-7168
(918) 376-2529
(918) 376-2548
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1042
OK
Other
Enumeration date
11/15/2011
Last updated
08/30/2012
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