Provider Demographics
NPI:1881656544
Name:CROSS, HOLLY ANN (RD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANN
Last Name:CROSS
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 1:10718 S 337TH WEST AVE
Mailing Address - Street 2:
Mailing Address - City:MANNFORD
Mailing Address - State:OK
Mailing Address - Zip Code:74044-6057
Mailing Address - Country:US
Mailing Address - Phone:918-908-0027
Mailing Address - Fax:
Practice Address - Street 1:10718 S 337TH WEST AVE
Practice Address - Street 2:
Practice Address - City:MANNFORD
Practice Address - State:OK
Practice Address - Zip Code:74044-6057
Practice Address - Country:US
Practice Address - Phone:918-908-0027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT04727133V00000X
OK2268133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ48223Medicare UPIN
TX8D9239Medicare ID - Type Unspecified