Provider Demographics
NPI:1336101203
Name:CROSSWHITE, KATRINA D (MS,RD/LD)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:D
Last Name:CROSSWHITE
Suffix:
Gender:F
Credentials:MS,RD/LD
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:D
Other - Last Name:CASTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6100 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-1044
Mailing Address - Country:US
Mailing Address - Phone:405-935-2163
Mailing Address - Fax:405-849-2163
Practice Address - Street 1:6100 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-1044
Practice Address - Country:US
Practice Address - Phone:405-935-2163
Practice Address - Fax:405-849-2163
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1311133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered