Provider Demographics
NPI:1023102795
Name:DAVIS-WHITENACK, MELISSA L (MS, RD,LD)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:L
Last Name:DAVIS-WHITENACK
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 1:5870 S. 76TH EAST AVENUE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-9323
Mailing Address - Country:US
Mailing Address - Phone:918-622-9099
Mailing Address - Fax:
Practice Address - Street 1:5870 S. 76TH EAST AVENUE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-9323
Practice Address - Country:US
Practice Address - Phone:918-622-9099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK888133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered