Provider Demographics
NPI:1659423184
Name:FOUT, DEBRA RENEE (RD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:RENEE
Last Name:FOUT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 487
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-0487
Mailing Address - Country:US
Mailing Address - Phone:918-721-9290
Mailing Address - Fax:918-658-2663
Practice Address - Street 1:16511 STATE HIGHWAY 83
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-0487
Practice Address - Country:US
Practice Address - Phone:918-721-9290
Practice Address - Fax:918-658-2663
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLD718133V00000X
AR1025133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered