Provider Demographics
NPI:1609090372
Name:PACIFIC, SUSAN KAY (RD,LD)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:KAY
Last Name:PACIFIC
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:PO BOX 1330
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-1330
Mailing Address - Country:US
Mailing Address - Phone:405-307-6630
Mailing Address - Fax:405-307-6660
Practice Address - Street 1:3400 W TECUMSEH RD
Practice Address - Street 2:STE 206
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-1810
Practice Address - Country:US
Practice Address - Phone:405-307-5731
Practice Address - Fax:405-307-3719
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2025-01-23
Deactivation Date:2023-06-14
Deactivation Code:
Reactivation Date:2025-01-23
Provider Licenses
StateLicense IDTaxonomies
OK958133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered