Provider Demographics
NPI:1295747376
Name:BAKER, PATSY SUE (RD,LD)
Entity type:Individual
Prefix:
First Name:PATSY
Middle Name:SUE
Last Name:BAKER
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7502 W 35TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74107-4544
Mailing Address - Country:US
Mailing Address - Phone:918-445-0889
Mailing Address - Fax:866-833-7629
Practice Address - Street 1:7502 W 35TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74107-4544
Practice Address - Country:US
Practice Address - Phone:918-445-0889
Practice Address - Fax:866-833-7629
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1089133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered