Provider Demographics
NPI:1215269592
Name:CALLINS, UMO (MS,RD/LD)
Entity type:Individual
Prefix:MRS
First Name:UMO
Middle Name:
Last Name:CALLINS
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 1:16404 JOSIAH PL
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-9730
Mailing Address - Country:US
Mailing Address - Phone:405-837-7003
Mailing Address - Fax:
Practice Address - Street 1:3330 NW 56TH ST STE 608
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4470
Practice Address - Country:US
Practice Address - Phone:405-885-0270
Practice Address - Fax:405-300-4492
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-11
Last Update Date:2019-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1609133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200398760AMedicaid