Individual
MRS. STACY MARIE HASTEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD/LD
Contact information
Practice address
714 W. 16TH ST., OKMULGEE, OK 74447-6218
(918) 756-5560
(888) 322-5168
Mailing address
20284 CEDAR RD., HENRYETTA, OK 74437-7284
(918) 756-5560
(888) 322-5168
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1617
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200248390A
—
OK
01
—
OKB5648
MEDICARE PTAN
OK
Enumeration date
05/29/2009
Last updated
09/04/2020
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