Provider Demographics
NPI:1013245638
Name:HEUER, MELISSA KIRBY (RD, LD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:KIRBY
Last Name:HEUER
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:SUE
Other - Last Name:KIRBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 246
Mailing Address - Street 2:
Mailing Address - City:STROUD
Mailing Address - State:OK
Mailing Address - Zip Code:74079-9652
Mailing Address - Country:US
Mailing Address - Phone:918-968-9531
Mailing Address - Fax:918-968-1532
Practice Address - Street 1:RR 2 BOX 246
Practice Address - Street 2:
Practice Address - City:STROUD
Practice Address - State:OK
Practice Address - Zip Code:74079-9652
Practice Address - Country:US
Practice Address - Phone:918-968-9531
Practice Address - Fax:918-968-1532
Is Sole Proprietor?:No
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1682133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered