Provider Demographics
NPI:1497334247
Name:DIGESTIVE HEALTH NUTRITION LLC
Entity Type:Organization
Organization Name:DIGESTIVE HEALTH NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:DESTINY
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, LD, CNSC
Authorized Official - Phone:405-630-9018
Mailing Address - Street 1:3126 S BOULEVARD STE 127
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12051 QUAIL RIDGE CIR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034
Practice Address - Country:US
Practice Address - Phone:405-960-3120
Practice Address - Fax:405-960-3125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-07
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty