Individual
ALEXA NICOLE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RD, LD
Contact information
Practice address
6160 S YALE AVE, TULSA, OK 74136-1900
(918) 497-3140
(918) 499-3295
Mailing address
6600 S YALE AVE STE 1200, TULSA, OK 74136-3333
(918) 488-6653
(918) 488-6098
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2528
OK
Other
Enumeration date
04/27/2022
Last updated
05/10/2022
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