Provider Demographics
NPI:1801403894
Name:NUTRITION MANAGEMENT SERVICES, INC.
Entity Type:Organization
Organization Name:NUTRITION MANAGEMENT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:RD/LD
Authorized Official - Phone:918-630-7534
Mailing Address - Street 1:1216 E KENOSHA ST # 265
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-2007
Mailing Address - Country:US
Mailing Address - Phone:918-630-7534
Mailing Address - Fax:
Practice Address - Street 1:27761 E 61ST ST S
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74014-8515
Practice Address - Country:US
Practice Address - Phone:918-630-7534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty