Provider Demographics
NPI:1609201599
Name:ALLEN, JENNIFER J (RD, LD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:ALLEN
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:J
Other - Last Name:TOLBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:200 N BRYANT AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6273
Mailing Address - Country:US
Mailing Address - Phone:405-330-2363
Mailing Address - Fax:
Practice Address - Street 1:200 N BRYANT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6273
Practice Address - Country:US
Practice Address - Phone:405-330-2363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1750133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered