Provider Demographics
NPI:1194169532
Name:BEARD, JENNIFER (MS, RD/LD)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:BEARD
Suffix:
Gender:F
Credentials:MS, RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CHILDRENS AVE # BNP-5021
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-4637
Mailing Address - Country:US
Mailing Address - Phone:405-271-8001
Mailing Address - Fax:
Practice Address - Street 1:120 N BRYANT AVE
Practice Address - Street 2:SUITE A-9
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6302
Practice Address - Country:US
Practice Address - Phone:405-285-4762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-27
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1873133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered