Individual
JENNIFER RACHELLE HOLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD/LD-CDE
Contact information
Practice address
408 S CHERRY ST, SALLISAW, OK 74955-6602
(918) 774-5074
Mailing address
408 S CHERRY ST, SALLISAW, OK 74955-6602
(918) 774-5074
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD1057
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200057610A
—
OK
01
—
200057610B
OHCA DDSD WAIVER
OK
01
—
8E279B
PART B
OK
Enumeration date
08/31/2006
Last updated
08/23/2011
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