Individual
MRS. GRACE BALLEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
12697 E 51ST ST, TULSA, OK 74146-6236
(918) 505-3201
(919) 505-3258
Mailing address
9386 S 278TH EAST AVE, BROKEN ARROW, OK 74014-4305
(405) 334-2101
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2088
OK
133V00000X
Registered Dietitian
86020939
OK
Other
Enumeration date
10/13/2016
Last updated
01/14/2021
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