Provider Demographics
NPI:1043246242
Name:NUTRITION PARTNERS LLC
Entity Type:Organization
Organization Name:NUTRITION PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:SHEETS
Authorized Official - Last Name:COOKE
Authorized Official - Suffix:
Authorized Official - Credentials:RD/LD
Authorized Official - Phone:405-848-9344
Mailing Address - Street 1:9636 N MAY AVE
Mailing Address - Street 2:SUITE 274
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-2727
Mailing Address - Country:US
Mailing Address - Phone:405-848-9344
Mailing Address - Fax:405-302-0333
Practice Address - Street 1:9636 N MAY AVE
Practice Address - Street 2:SUITE 274
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-2727
Practice Address - Country:US
Practice Address - Phone:405-848-9344
Practice Address - Fax:405-302-0333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200072640AMedicaid
OK200072640AMedicaid