Provider Demographics
NPI:1265784318
Name:DEASON, ANGELA RENE (RD/LD)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:RENE
Last Name:DEASON
Suffix:
Gender:F
Credentials:RD/LD
Other - Prefix:MRS
Other - First Name:ANGIE
Other - Middle Name:RENE
Other - Last Name:DEASON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD/LD
Mailing Address - Street 1:3300 NW EXPRESSWAY ATTN: 100-5400
Mailing Address - Street 2:BUILDING D STE 120
Mailing Address - City:OKC
Mailing Address - State:OK
Mailing Address - Zip Code:73112
Mailing Address - Country:US
Mailing Address - Phone:405-949-6000
Mailing Address - Fax:405-949-6093
Practice Address - Street 1:3300 NW EXPRESSWAY ATTN: 100-5400
Practice Address - Street 2:BUILDING D STE 120
Practice Address - City:OKC
Practice Address - State:OK
Practice Address - Zip Code:73112
Practice Address - Country:US
Practice Address - Phone:405-949-6000
Practice Address - Fax:405-949-6093
Is Sole Proprietor?:No
Enumeration Date:2012-10-12
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1084133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered