Provider Demographics
NPI:1699404327
Name:HARMON, JULIE (RD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:HARMON
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 1:12535 W 63RD ST S
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-7203
Mailing Address - Country:US
Mailing Address - Phone:918-231-3280
Mailing Address - Fax:
Practice Address - Street 1:1819 E 19TH ST STE 301
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5407
Practice Address - Country:US
Practice Address - Phone:918-744-2444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2599133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1154417368Medicaid