Provider Demographics
NPI:1326665548
Name:TROUT, OLIVIA JEAN (MS, RD)
Entity Type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:JEAN
Last Name:TROUT
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 E 2ND ST APT 1110
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6353
Mailing Address - Country:US
Mailing Address - Phone:405-996-7711
Mailing Address - Fax:
Practice Address - Street 1:4311 SE 57TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73135-3308
Practice Address - Country:US
Practice Address - Phone:405-996-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-03
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2517133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered