Provider Demographics
NPI:1790015980
Name:PURDY, KRISTIE ANN (MS, RD/LD)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIE
Middle Name:ANN
Last Name:PURDY
Suffix:
Gender:F
Credentials:MS, 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:RR 1 BOX 3060
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-9303
Mailing Address - Country:US
Mailing Address - Phone:580-331-3458
Mailing Address - Fax:580-323-2579
Practice Address - Street 1:RR 1 BOX 3060
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-9303
Practice Address - Country:US
Practice Address - Phone:580-331-3458
Practice Address - Fax:580-323-2579
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1634133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered