Provider Demographics
NPI:1548312408
Name:WELBORN, CHRISTIAN DIXON (RD, LD, CDE)
Entity type:Individual
Prefix:MRS
First Name:CHRISTIAN
Middle Name:DIXON
Last Name:WELBORN
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:MS
Other - First Name:CHRISTIAN
Other - Middle Name:BROOKE
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:10026 S MINGO RD STE A
Mailing Address - Street 2:PMB 105
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5717
Mailing Address - Country:US
Mailing Address - Phone:918-850-4914
Mailing Address - Fax:
Practice Address - Street 1:550 S PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-3820
Practice Address - Country:US
Practice Address - Phone:918-588-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK963238133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered