Provider Demographics
NPI:1639686660
Name:FARLEY, KELCIE ALAYNE (RD/LD)
Entity Type:Individual
Prefix:
First Name:KELCIE
Middle Name:ALAYNE
Last Name:FARLEY
Suffix:
Gender:F
Credentials:RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2522 NW 16TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-4840
Mailing Address - Country:US
Mailing Address - Phone:918-441-1663
Mailing Address - Fax:
Practice Address - Street 1:115 W 3RD ST STE 800
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74103-3411
Practice Address - Country:US
Practice Address - Phone:918-585-3045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-28
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2256133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered