Individual
KELLIE R BRYANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1201 HERITAGE CIR, PAWNEE, OK 74058-3744
(918) 762-6638
Mailing address
1201 HERITAGE CIR, PAWNEE, OK 74058-3744
(918) 762-6638
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
805
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8HD668
MEDICARE PROVIDER NUMBER
OK
Enumeration date
09/26/2007
Last updated
09/26/2007
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