Basic Information
Provider Information | |||||||||
NPI: | 1770047789 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HARRIS | ||||||||
FirstName: | CHRISTINA | ||||||||
MiddleName: | ANNA | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MS, RDN, LD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | RALSTON | ||||||||
OtherFirstName: | CHRISTINA | ||||||||
OtherMiddleName: | ANNA | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MS, RDN, LD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 550 S PEORIA AVE | ||||||||
Address2: |   | ||||||||
City: | TULSA | ||||||||
State: | OK | ||||||||
PostalCode: | 741203820 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9185881900 | ||||||||
FaxNumber: | 9183821285 | ||||||||
Practice Location | |||||||||
Address1: | 7027 OLD MADISON PIKE NW STE 108 | ||||||||
Address2: |   | ||||||||
City: | HUNTSVILLE | ||||||||
State: | AL | ||||||||
PostalCode: | 358062369 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2565306040 | ||||||||
FaxNumber: | 2569373313 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/23/2019 | ||||||||
LastUpdateDate: | 11/18/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 11/18/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 2358 | OK | N |   | Dietary & Nutritional Service Providers | Dietitian, Registered |   | 133V00000X | 3377 | AL | Y |   | Dietary & Nutritional Service Providers | Dietitian, Registered |   |
No ID Information.