Organization
KELLY S. BEALS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLY S. BEALS RD/LD (DIETITIAN)
(405) 795-8535
Entity
Organization
Contact information
Practice address
3220 ROCKHAMPTON AVE, OKLAHOMA CITY, OK 73179-1223
(405) 795-8535
Mailing address
3220 ROCKHAMPTON AVE, OKLAHOMA CITY, OK 73179-1223
(405) 795-8535
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1076
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1013017003
INDIVIDUAL NPI (PRIOR TO FORMING CORPORATION)
OK
01
—
1076
LICENSED DIETITIAN
OK
05
—
200089850A
—
OK
01
—
863540
REGISTERED DIETITIAN
OK
Enumeration date
07/16/2008
Last updated
07/16/2008
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