Individual
MS. MARY NELL SOUTHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D.,L.D.
Contact information
Practice address
1 CHOCTAW WAY, NUTRITION SERVICES, TALIHINA, OK 74571-2022
(918) 567-7000
Mailing address
HC 69 BOX 245, SNOW, OK 74567-9717
(918) 755-4364
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
119
OK
Other
Enumeration date
04/09/2007
Last updated
07/08/2007
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