Provider Demographics
NPI:1659916336
Name:BARNETT, COLLEEN (RD)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:BARNETT
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 1:9017 N UNIVERSITY AVE APT 8102
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-4353
Mailing Address - Country:US
Mailing Address - Phone:847-791-6086
Mailing Address - Fax:
Practice Address - Street 1:9700 MASHBURN BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-5509
Practice Address - Country:US
Practice Address - Phone:405-721-2466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-17
Last Update Date:2019-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2333133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty