Individual
JOLEEN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD/LD
Contact information
Practice address
6336 S 116TH EAST AVE, BROKEN ARROW, OK 74012-1251
(918) 280-8456
(855) 438-6802
Mailing address
1701 S MAIN ST, PMB 2735, BROKEN ARROW, OK 74013-9701
(918) 280-8456
(855) 438-6802
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1842
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1842
LD
OK
Enumeration date
05/20/2009
Last updated
12/31/2023
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