Provider Demographics
NPI:1427175744
Name:MILLS, JERI A (RD,LD, CDE)
Entity type:Individual
Prefix:
First Name:JERI
Middle Name:A
Last Name:MILLS
Suffix:
Gender:F
Credentials:RD,LD, CDE
Other - Prefix:
Other - First Name:JERI
Other - Middle Name:JENNINGS
Other - Last Name:MILLS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD,LD, CDE
Mailing Address - Street 1:6600 S YALE AVE STE 1200
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3333
Mailing Address - Country:US
Mailing Address - Phone:918-488-6687
Mailing Address - Fax:918-488-6098
Practice Address - Street 1:6160 S YALE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136
Practice Address - Country:US
Practice Address - Phone:918-499-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK974133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200113860AMedicaid
OKOK402269Medicare PIN