Provider Demographics
NPI:1417640681
Name:NOURISHED BY RACHEL, LLC
Entity type:Organization
Organization Name:NOURISHED BY RACHEL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:BENIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:918-638-9106
Mailing Address - Street 1:2838 S 73RD EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74129-6286
Mailing Address - Country:US
Mailing Address - Phone:918-638-9106
Mailing Address - Fax:
Practice Address - Street 1:2838 S 73RD EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-6286
Practice Address - Country:US
Practice Address - Phone:918-638-9106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-01
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1417349291Medicaid