Provider Demographics
NPI:1114109816
Name:NEWTON, JENNIFER IRENE (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:IRENE
Last Name:NEWTON
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:IRENE
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:1001 S. 41ST STREET EAST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403
Mailing Address - Country:US
Mailing Address - Phone:918-781-6500
Mailing Address - Fax:918-686-8398
Practice Address - Street 1:1001 S. 41ST STREET EAST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403
Practice Address - Country:US
Practice Address - Phone:918-781-6500
Practice Address - Fax:918-686-8398
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1482133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered