Provider Demographics
NPI:1366852733
Name:HUSSEY, SAMANTHA MARIE (RD, CSO, LD)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:MARIE
Last Name:HUSSEY
Suffix:
Gender:F
Credentials:RD, CSO, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1122 NE 13TH ST
Mailing Address - Street 2:ORI 274
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73117-1039
Mailing Address - Country:US
Mailing Address - Phone:405-271-8880
Mailing Address - Fax:405-208-8732
Practice Address - Street 1:101 N ROBINSON AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-5504
Practice Address - Country:US
Practice Address - Phone:405-271-8880
Practice Address - Fax:405-208-8732
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-06
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1975133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered