Provider Demographics
NPI:1164686655
Name:WELLS, CARRYE LUREE (RD/LD)
Entity type:Individual
Prefix:MS
First Name:CARRYE
Middle Name:LUREE
Last Name:WELLS
Suffix:
Gender:F
Credentials:RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 E GEORGIA ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-3039
Mailing Address - Country:US
Mailing Address - Phone:405-275-9456
Mailing Address - Fax:
Practice Address - Street 1:804 E GEORGIA ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-3039
Practice Address - Country:US
Practice Address - Phone:405-275-9456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1063133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered