Provider Demographics
NPI:1235988650
Name:TROTTER, KRISTEN (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:TROTTER
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2704 HAMDEN AVE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-9614
Mailing Address - Country:US
Mailing Address - Phone:817-524-5821
Mailing Address - Fax:
Practice Address - Street 1:2704 HAMDEN AVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-9614
Practice Address - Country:US
Practice Address - Phone:817-524-5821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2733133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered