Provider Demographics
NPI:1205583135
Name:HUNNICUTT, PAULA MARIE (CHN)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:MARIE
Last Name:HUNNICUTT
Suffix:
Gender:F
Credentials:CHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23127 E 930 RD
Mailing Address - Street 2:
Mailing Address - City:CUSTER CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73639-3900
Mailing Address - Country:US
Mailing Address - Phone:580-309-2828
Mailing Address - Fax:
Practice Address - Street 1:23127 E 930 RD
Practice Address - Street 2:
Practice Address - City:CUSTER CITY
Practice Address - State:OK
Practice Address - Zip Code:73639-3900
Practice Address - Country:US
Practice Address - Phone:580-309-2828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14772133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education