Provider Demographics
NPI:1205271541
Name:ADVANCED NUTRITION CONSULTANTS
Entity type:Organization
Organization Name:ADVANCED NUTRITION CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN / OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAMKIN
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:405-285-4762
Mailing Address - Street 1:120 N BRYANT AVE
Mailing Address - Street 2:SUITE A-9
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6302
Mailing Address - Country:US
Mailing Address - Phone:405-285-4762
Mailing Address - Fax:405-285-4352
Practice Address - Street 1:120 N BRYANT AVE
Practice Address - Street 2:SUITE A-9
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6302
Practice Address - Country:US
Practice Address - Phone:405-285-4752
Practice Address - Fax:405-285-4352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-30
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1236133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty