Provider Demographics
NPI:1588228324
Name:VEATCH, MELISSA ALICE (MS RD/LD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ALICE
Last Name:VEATCH
Suffix:
Gender:F
Credentials:MS RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 GERALD CT
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-1130
Mailing Address - Country:US
Mailing Address - Phone:206-930-8075
Mailing Address - Fax:
Practice Address - Street 1:1200 CHILDRENS AVE STE 12400
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4637
Practice Address - Country:US
Practice Address - Phone:206-930-8075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-26
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2267133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered