Provider Demographics
NPI:1659152734
Name:REDDING, ALLISON GRAYCE (RDN, LD)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:GRAYCE
Last Name:REDDING
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1528 E DON ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-2321
Mailing Address - Country:US
Mailing Address - Phone:918-213-5997
Mailing Address - Fax:
Practice Address - Street 1:4150 SE ADAMS RD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-8410
Practice Address - Country:US
Practice Address - Phone:191-833-1997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT85495133V00000X
OK2176133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered