Provider Demographics
NPI:1669253761
Name:MCCAFFERTY, MONICA GREGORY (CNS)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:GREGORY
Last Name:MCCAFFERTY
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9249 S URBANA AVE UNIT E
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-3941
Mailing Address - Country:US
Mailing Address - Phone:979-966-3228
Mailing Address - Fax:
Practice Address - Street 1:9249 S URBANA AVE UNIT E
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-3941
Practice Address - Country:US
Practice Address - Phone:979-966-3228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
18465133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist