Individual
ELLEN LOUISE HICKERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD/LD
Contact information
Practice address
7800 BOB WHITE TRL, JONES, OK 73049-3424
(405) 771-3936
(405) 771-3936
Mailing address
7800 BOB WHITE TRL, JONES, OK 73049-3424
(405) 771-3936
(405) 771-3936
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
850
OK
Other
Enumeration date
11/02/2009
Last updated
11/02/2009
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