Basic Information
| Provider Information | |||||||||
| NPI: | 1548990914 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUMNER-DAVIS | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | ELLEN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MS, RD, LD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12611 S 1ST ST | ||||||||
| Address2: | |||||||||
| City: | JENKS | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740372950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186915373 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1819 E 19TH ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741045413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187442444 | ||||||||
| FaxNumber: | 9188565503 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2022 | ||||||||
| LastUpdateDate: | 07/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 863 | OK | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.