Provider Demographics
NPI:1164646576
Name:CARTER, MARY LOVELADY (MS, RD, LD, CDE)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LOVELADY
Last Name:CARTER
Suffix:
Gender:F
Credentials:MS, RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7106 E. 150TH STREET N
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74021
Mailing Address - Country:US
Mailing Address - Phone:918-371-3253
Mailing Address - Fax:
Practice Address - Street 1:7106 E 150TH ST N
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:OK
Practice Address - Zip Code:74021-4096
Practice Address - Country:US
Practice Address - Phone:918-371-3253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK854133V00000X
TXDT02168133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered