Individual
AMANDA KAYLENE HUMPHREYS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
52984 423RD AVE, TALIHINA, OK 74571-2053
(580) 272-7689
Mailing address
52984 423RD AVE, TALIHINA, OK 74571-2053
(580) 272-7689
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2979
OK
Other
Enumeration date
06/21/2024
Last updated
11/19/2024
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