Doctor Name: | MS. JESSICA TILLEY |
NPI Number: | 1013294255 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RD, LD |
License Number: | 1042 |
Business Practice Address: | 8505 N 129th East Ave Owasso, OK - 740557168 |
Business Phone Number: | 9183762529 |
Business Fax Number: | 9183762548 |
Mailing Address: | 8505 N 129th East Ave, OWASSO |
State: | OK |
Postal Code: | 740557168 |
Phone Number: | 9183762529 |
Fax Number: | 9183762548 |
NPI Enumeration Date: | 11/15/2011 |
NPI Last Update Date: | 08/30/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 133V00000X |
License Number: | 1042 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Dietary & Nutritional Service Providers |
Taxonomy Classification: | Dietitian, Registered |
Taxonomy Specialization: | |
Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |