Provider Demographics
NPI:1922576339
Name:ONE IN A MELON DIETITIAN SERVICES, LLC
Entity Type:Organization
Organization Name:ONE IN A MELON DIETITIAN SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD/LD
Authorized Official - Phone:918-924-6808
Mailing Address - Street 1:2800 N 23RD ST APT 2021
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-2044
Mailing Address - Country:US
Mailing Address - Phone:918-861-7658
Mailing Address - Fax:
Practice Address - Street 1:1978 W 65TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74132-1931
Practice Address - Country:US
Practice Address - Phone:918-924-6808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-05
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200792580AMedicaid