Provider Demographics
NPI:1053282665
Name:HART, SAMANTHA (MS, RD)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:NIELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:406 S BOULDER AVE STE 507
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74103-3869
Mailing Address - Country:US
Mailing Address - Phone:817-907-5301
Mailing Address - Fax:
Practice Address - Street 1:6655 S YALE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3326
Practice Address - Country:US
Practice Address - Phone:918-491-3700
Practice Address - Fax:918-481-4063
Is Sole Proprietor?:No
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered