Provider Demographics
NPI:1730581836
Name:NELMS, TIFFANI MARIE (RD/LD)
Entity type:Individual
Prefix:MRS
First Name:TIFFANI
Middle Name:MARIE
Last Name:NELMS
Suffix:
Gender:F
Credentials:RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4775 E 91ST ST STE 100
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-2805
Mailing Address - Country:US
Mailing Address - Phone:918-551-7901
Mailing Address - Fax:918-388-1059
Practice Address - Street 1:4775 E 91ST ST STE 100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-2805
Practice Address - Country:US
Practice Address - Phone:918-551-7901
Practice Address - Fax:918-388-1059
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1995133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered