Pba Wellness,LLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

1678 Issued in OK

Legal business name

PBA WELLNESS,LLC

Practice address

4775 E 91St St
Tulsa, OK 74137-2801

Phone

(918) 496-2000

Fax

(918) 496-2338

NPI assigned

Oct 2, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Elizabeth Christine Miller, RD/LD

Title

Dietitian

Phone

(918) 551-7901

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1380672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380672000000",
    "number": "1619304847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4775 E 91ST ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741372801",
            "telephone_number": "918-496-2000",
            "fax_number": "918-496-2338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4775 E 91ST ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741372801",
            "telephone_number": "918-496-2000",
            "fax_number": "918-496-2338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PBA WELLNESS,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-02",
        "last_updated": "2013-10-02",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "CHRISTINE",
        "authorized_official_title_or_position": "DIETITIAN",
        "authorized_official_telephone_number": "918-551-7901",
        "authorized_official_credential": "RD/LD"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": "OK",
            "license": "1678",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Registered Dietitian in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Registered Dietitian in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.