Provider Demographics
NPI:1093807109
Name:RANKIN, MELODY L (RD LD)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:L
Last Name:RANKIN
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 RIDGE LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-4158
Mailing Address - Country:US
Mailing Address - Phone:405-414-4424
Mailing Address - Fax:405-321-5924
Practice Address - Street 1:3101 RIDGE LAKE BLVD
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-4158
Practice Address - Country:US
Practice Address - Phone:405-414-4424
Practice Address - Fax:405-321-5924
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLD 568133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100659480AMedicaid
OKOKA100331Medicare PIN