Provider Demographics
NPI:1871270017
Name:SIMONSON, TIFFANY (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:SIMONSON
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 1:115 W 3RD ST STE 802
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74103-3410
Mailing Address - Country:US
Mailing Address - Phone:918-574-8598
Mailing Address - Fax:918-585-3047
Practice Address - Street 1:115 W 3RD ST STE 802
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74103-3410
Practice Address - Country:US
Practice Address - Phone:918-574-8598
Practice Address - Fax:918-585-3047
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1799133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered