Individual
MRS. TANYA R HUMPHREY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS, NDTR
Contact information
Practice address
12 BUFFALO PL, BURNEYVILLE, OK 73430-2136
(580) 276-9003
Mailing address
12 BUFFALO PL, BURNEYVILLE, OK 73430-2136
(580) 276-9003
Taxonomy
Speciality
Code
Description
License number
State
136A00000X
Registered Dietetic Technician
Primary
—
—
Other
Enumeration date
10/12/2019
Last updated
10/12/2019
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