Provider Demographics
NPI:1114001948
Name:THOMPSON, SUMMER WILSON (RD/LD)
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:WILSON
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RD/LD
Other - Prefix:
Other - First Name:SUMMER
Other - Middle Name:RENAE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5332 E 20TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74112-6918
Mailing Address - Country:US
Mailing Address - Phone:918-712-9224
Mailing Address - Fax:
Practice Address - Street 1:1007 S PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-4495
Practice Address - Country:US
Practice Address - Phone:918-858-5217
Practice Address - Fax:918-592-3024
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1329133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered