Provider Demographics
NPI:1871764126
Name:BEISSEL, KRISTY LYNNE (RD/LD)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:LYNNE
Last Name:BEISSEL
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 1:15334 E 89TH CT N
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-8508
Mailing Address - Country:US
Mailing Address - Phone:918-704-7052
Mailing Address - Fax:
Practice Address - Street 1:15334 E 89TH CT N
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-8508
Practice Address - Country:US
Practice Address - Phone:918-704-7052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1316133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered