Provider Demographics
NPI:1740829803
Name:CONNER, TAYLOR ROSE (REGISTERED DIETITIAN)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ROSE
Last Name:CONNER
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 NW 19TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-3830
Mailing Address - Country:US
Mailing Address - Phone:405-713-1125
Mailing Address - Fax:
Practice Address - Street 1:2500 NE 63RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73111-8203
Practice Address - Country:US
Practice Address - Phone:405-713-1125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2338133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered