Provider Demographics
NPI:1083804488
Name:RATCLIFF, KAMELA LYNIECE (MS, RD/LD)
Entity Type:Individual
Prefix:MRS
First Name:KAMELA
Middle Name:LYNIECE
Last Name:RATCLIFF
Suffix:
Gender:F
Credentials:MS, RD/LD
Other - Prefix:
Other - First Name:KAMI
Other - Middle Name:
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1428 W KANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73018-2930
Mailing Address - Country:US
Mailing Address - Phone:405-224-9443
Mailing Address - Fax:405-224-1190
Practice Address - Street 1:1428 W KANSAS AVE
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-2930
Practice Address - Country:US
Practice Address - Phone:405-224-9443
Practice Address - Fax:405-224-1190
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK861133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered