Individual
MRS. JENNIFER SOUTHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RD/LD
Contact information
Practice address
3120 S BOULEVARD STE 127, EDMOND, OK 73013-5308
(405) 960-3120
Mailing address
3126 S BOULEVARD STE 127, EDMOND, OK 73013-5308
(405) 960-3120
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1720
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1093087355
NPI
—
Enumeration date
02/02/2012
Last updated
03/03/2022
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