Basic Information
Provider Information | |||||||||
NPI: | 1164562542 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | FORSYTHE | ||||||||
FirstName: | ALISON | ||||||||
MiddleName: | PAIGE | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | RD,LD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ARRINGTON | ||||||||
OtherFirstName: | ALISON | ||||||||
OtherMiddleName: | PAIGE | ||||||||
OtherNamePrefix: | MISS | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | RD,LD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 550 S PEORIA AVE | ||||||||
Address2: |   | ||||||||
City: | TULSA | ||||||||
State: | OK | ||||||||
PostalCode: | 741203820 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9185881900 | ||||||||
FaxNumber: | 9185826405 | ||||||||
Practice Location | |||||||||
Address1: | 550 S PEORIA AVE | ||||||||
Address2: |   | ||||||||
City: | TULSA | ||||||||
State: | OK | ||||||||
PostalCode: | 741203820 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9185881900 | ||||||||
FaxNumber: | 9185826405 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/07/2007 | ||||||||
LastUpdateDate: | 06/17/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 1468 | OK | Y |   | Dietary & Nutritional Service Providers | Dietitian, Registered |   |
ID Information
ID | Type | State | Issuer | Description | 100732910-A | 01 | OK | GROUP MEDICAID/SOONERCARE | OTHER | 73-1042545 | 01 | OK | GROUP MEDICARE | OTHER | 731042545001 | 01 | OK | GROUP TRICARE | OTHER | 100732910-G | 01 | OK | GROUP MEDICAID/SOONERCARE | OTHER | 73-1042545 | 01 | OK | GROUP BCBS | OTHER | 200556340 A | 05 | OK |   | MEDICAID | 73-1042545 | 01 | OK | GROUP COMMUNITY CARE OF OKLAHOMA | OTHER |