Provider Demographics
NPI:1396934683
Name:SPECHT-PILGRIM, MISTY D (RD, LD)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:D
Last Name:SPECHT-PILGRIM
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:D
Other - Last Name:RAINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:300 ROCKEFELLER DR
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-5075
Mailing Address - Country:US
Mailing Address - Phone:918-840-0261
Mailing Address - Fax:
Practice Address - Street 1:300 ROCKEFELLER DR
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-5075
Practice Address - Country:US
Practice Address - Phone:918-840-0261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK955133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered