Provider Demographics
NPI:1508359118
Name:HARRY, JAMIE MCCASLIN (RD, RN)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:MCCASLIN
Last Name:HARRY
Suffix:
Gender:F
Credentials:RD, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 TUSKAWILLA RD
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-4401
Mailing Address - Country:US
Mailing Address - Phone:407-637-0273
Mailing Address - Fax:
Practice Address - Street 1:2021 S LEWIS AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5733
Practice Address - Country:US
Practice Address - Phone:918-749-9077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16436133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered