Provider Demographics
NPI:1548990914
Name:SUMNER-DAVIS, CHRISTINE ELLEN (MS, RD, LD)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ELLEN
Last Name:SUMNER-DAVIS
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 1:12611 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-2950
Mailing Address - Country:US
Mailing Address - Phone:918-691-5373
Mailing Address - Fax:
Practice Address - Street 1:1819 E 19TH ST STE 300
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5413
Practice Address - Country:US
Practice Address - Phone:918-744-2444
Practice Address - Fax:918-856-5503
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK863133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered