Provider Demographics
NPI: | 1205857299 |
---|---|
Name: | VAN CAMP, MEGHAN MURPHY (RDN, LD, CDE) |
Entity Type: | Individual |
Prefix: | MRS |
First Name: | MEGHAN |
Middle Name: | MURPHY |
Last Name: | VAN CAMP |
Suffix: | |
Gender: | F |
Credentials: | RDN, LD, CDE |
Other - Prefix: | MISS |
Other - First Name: | MEGHAN |
Other - Middle Name: | FRANCES |
Other - Last Name: | MURPHY |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | RD, LD/N |
Mailing Address - Street 1: | 5601 NW 72ND ST STE 200 |
Mailing Address - Street 2: | |
Mailing Address - City: | WARR ACRES |
Mailing Address - State: | OK |
Mailing Address - Zip Code: | 73132-5920 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 405-603-1941 |
Mailing Address - Fax: | 405-603-1942 |
Practice Address - Street 1: | 5601 NW 72ND ST STE 200 |
Practice Address - Street 2: | |
Practice Address - City: | WARR ACRES |
Practice Address - State: | OK |
Practice Address - Zip Code: | 73132 |
Practice Address - Country: | US |
Practice Address - Phone: | 405-603-1941 |
Practice Address - Fax: | 405-603-1942 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2006-07-22 |
Last Update Date: | 2018-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OK | 1977 | 133V00000X |
FL | ND4278 | 133V00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 133V00000X | Dietary & Nutritional Service Providers | Dietitian, Registered | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
591561574 | Other | EIN | |
591561574 | Other | EIN |