Provider Demographics
NPI:1639543424
Name:RADCLIFF HEFNER, ADRIENNE ELIZABETH (RD/LD)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:ELIZABETH
Last Name:RADCLIFF HEFNER
Suffix:
Gender:F
Credentials:RD/LD
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:ELIZABETH
Other - Last Name:RADCLIFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD/LD
Mailing Address - Street 1:5335 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-6305
Mailing Address - Country:US
Mailing Address - Phone:918-625-6263
Mailing Address - Fax:
Practice Address - Street 1:4200 W MEMORIAL RD STE 508
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8359
Practice Address - Country:US
Practice Address - Phone:918-755-7561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-17
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2093133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered