Individual
BEVERLY LYNN PRENTICE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., R.D., L.D.
Contact information
Practice address
10105 BRIDGEWATER CIR, OWASSO, OK 74055-7727
(918) 272-4267
(918) 274-4227
Mailing address
10105 BRIDGEWATER CIR, OWASSO, OK 74055-7727
(918) 272-4267
(918) 274-4227
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1488
OK
Other
Enumeration date
01/26/2007
Last updated
07/08/2007
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