Provider Demographics
NPI:1972043529
Name:OAKLEY, MONICA (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:OAKLEY
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:OAKLEY
Other - Last Name:BASNIGHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, RD, LD
Mailing Address - Street 1:810 N ISABELLA ST
Mailing Address - Street 2:
Mailing Address - City:SYLVESTER
Mailing Address - State:GA
Mailing Address - Zip Code:31791-1314
Mailing Address - Country:US
Mailing Address - Phone:910-795-7915
Mailing Address - Fax:
Practice Address - Street 1:810 N ISABELLA ST
Practice Address - Street 2:
Practice Address - City:SYLVESTER
Practice Address - State:GA
Practice Address - Zip Code:31791-1314
Practice Address - Country:US
Practice Address - Phone:910-795-7915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003994133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered