Provider Demographics
NPI:1346601317
Name:EBERS, BRITTANY LAREE (RD/LD)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:LAREE
Last Name:EBERS
Suffix:
Gender:F
Credentials:RD/LD
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:LAREE
Other - Last Name:STAPLETON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 638
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74352-0638
Mailing Address - Country:US
Mailing Address - Phone:918-864-1213
Mailing Address - Fax:
Practice Address - Street 1:300 ROCKEFELLER DR
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-5075
Practice Address - Country:US
Practice Address - Phone:918-682-5501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2145133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered