Provider Demographics
NPI:1316385552
Name:PARKISON, LARITA DENISE (RD, CSR, LD)
Entity Type:Individual
Prefix:
First Name:LARITA
Middle Name:DENISE
Last Name:PARKISON
Suffix:
Gender:F
Credentials:RD, CSR, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 385
Mailing Address - Street 2:307 OLIVE
Mailing Address - City:NORTH MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74358-0385
Mailing Address - Country:US
Mailing Address - Phone:918-541-5185
Mailing Address - Fax:
Practice Address - Street 1:307 OLIVE
Practice Address - Street 2:BOX 385
Practice Address - City:NORTH MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74358-0385
Practice Address - Country:US
Practice Address - Phone:918-541-5185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1440133V00000X, 133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered