Provider Demographics
NPI:1225919814
Name:KIRKLAND, MAUDIE SHANEA (RDN)
Entity type:Individual
Prefix:
First Name:MAUDIE
Middle Name:SHANEA
Last Name:KIRKLAND
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2091 CALI JO CT UNIT 1
Mailing Address - Street 2:
Mailing Address - City:BLANCHARD
Mailing Address - State:OK
Mailing Address - Zip Code:73010-5324
Mailing Address - Country:US
Mailing Address - Phone:580-257-1414
Mailing Address - Fax:
Practice Address - Street 1:2091 CALI JO CT UNIT 1
Practice Address - Street 2:
Practice Address - City:BLANCHARD
Practice Address - State:OK
Practice Address - Zip Code:73010-5324
Practice Address - Country:US
Practice Address - Phone:580-257-1414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3187133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty