Provider Demographics
NPI:1427630961
Name:ODELL, LAKRISTA MICHELLE (RN, NRT, HN)
Entity type:Individual
Prefix:
First Name:LAKRISTA
Middle Name:MICHELLE
Last Name:ODELL
Suffix:
Gender:F
Credentials:RN, NRT, HN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 BAKER RD
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:OK
Mailing Address - Zip Code:73086-8666
Mailing Address - Country:US
Mailing Address - Phone:580-618-1109
Mailing Address - Fax:
Practice Address - Street 1:816 BAKER RD
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:OK
Practice Address - Zip Code:73086-8666
Practice Address - Country:US
Practice Address - Phone:580-618-1109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education