Provider Demographics
NPI:1306185657
Name:SOMMER, KRISTEN (RD)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:
Last Name:SOMMER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:KRISTEN
Other - Middle Name:SOMMER
Other - Last Name:KENNEALLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:2141 E 31ST PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-2207
Mailing Address - Country:US
Mailing Address - Phone:918-671-1055
Mailing Address - Fax:
Practice Address - Street 1:2141 E 31ST PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-2207
Practice Address - Country:US
Practice Address - Phone:918-671-1055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK763133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered