Provider Demographics
NPI:1245453232
Name:HUBBARD, SHERRY KAY (LD)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:KAY
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18508
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73154-0508
Mailing Address - Country:US
Mailing Address - Phone:405-818-6901
Mailing Address - Fax:405-818-6801
Practice Address - Street 1:4500 N CLASSEN BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-4834
Practice Address - Country:US
Practice Address - Phone:405-818-6801
Practice Address - Fax:405-818-6801
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK520133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered