Individual
MISS KELLI RAE LEE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, PLD
Contact information
Practice address
550 S PEORIA AVE, TULSA, OK 74120-3820
(918) 588-1900
(918) 582-6405
Mailing address
550 S PEORIA AVE, TULSA, OK 74120-3820
(918) 588-1900
(918) 582-6405
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
492
OK
Other
Enumeration date
02/07/2007
Last updated
07/08/2007
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