Provider Demographics
NPI:1043775281
Name:CAMPBELL, RUTH LYNNETTE (RDN)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:LYNNETTE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15405 N 186TH
Mailing Address - Street 2:
Mailing Address - City:HUNTER
Mailing Address - State:OK
Mailing Address - Zip Code:74640-0652
Mailing Address - Country:US
Mailing Address - Phone:580-684-7869
Mailing Address - Fax:
Practice Address - Street 1:15405 N 186TH
Practice Address - Street 2:
Practice Address - City:HUNTER
Practice Address - State:OK
Practice Address - Zip Code:74640-0652
Practice Address - Country:US
Practice Address - Phone:580-684-7869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK86133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKLD-86OtherDIETITIANS LICENSE