Individual
MICHELLE LIVESAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
1911 W C ST, JENKS, OK 74037-2367
(918) 409-0157
(918) 209-4788
Mailing address
1911 W C ST, JENKS, OK 74037-2367
(918) 409-0157
(918) 209-4788
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1499
OK
Other
Enumeration date
08/23/2016
Last updated
08/23/2016
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