Individual
TRACIE KENNON MATHIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD/LD IBCLC
Contact information
Practice address
6161 S YALE AVE, TULSA, OK 74136-1902
(918) 230-6409
Mailing address
8710 S 71ST EAST AVE, TULSA, OK 74133-5053
(918) 494-6455
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD932
OK
Other
Enumeration date
10/27/2007
Last updated
01/26/2022
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