Provider Demographics
NPI:1740989011
Name:HORN-SPECK, MELISSA (RDN/LD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:HORN-SPECK
Suffix:
Gender:F
Credentials:RDN/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17287 W 32ND ST S
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-4774
Mailing Address - Country:US
Mailing Address - Phone:918-280-9320
Mailing Address - Fax:918-221-8079
Practice Address - Street 1:17287 W 32ND ST S
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-4774
Practice Address - Country:US
Practice Address - Phone:918-280-9320
Practice Address - Fax:918-221-8079
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2072133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered