Individual
BLAKELY KECIA BERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3110 SW 89TH ST, STE 200E, OKLAHOMA CITY, OK 73159-7920
(405) 703-7300
(405) 703-7333
Mailing address
PO BOX 891328, OKLAHOMA CITY, OK 73189-1328
(405) 703-7300
(405) 703-7333
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2139
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2139
STATE LICENSE RD LD
OK
Enumeration date
08/03/2016
Last updated
08/03/2016
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