Provider Demographics
NPI:1881863330
Name:WILSEY, KENNETTE MONISA (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:KENNETTE
Middle Name:MONISA
Last Name:WILSEY
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17904 HASLEMERE LN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-4575
Mailing Address - Country:US
Mailing Address - Phone:405-359-4877
Mailing Address - Fax:
Practice Address - Street 1:17904 HASLEMERE LN
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-4575
Practice Address - Country:US
Practice Address - Phone:405-315-4877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1033133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered