Provider Demographics
NPI:1154586253
Name:BUTLER, DARCY DEE (RDN, LD)
Entity type:Individual
Prefix:
First Name:DARCY
Middle Name:DEE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 BLUESTEM RD
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74604-3201
Mailing Address - Country:US
Mailing Address - Phone:620-583-8080
Mailing Address - Fax:580-304-7430
Practice Address - Street 1:2508 BLUESTEM RD
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74604-3201
Practice Address - Country:US
Practice Address - Phone:620-583-8080
Practice Address - Fax:580-304-7430
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1588133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered