Provider Demographics
NPI:1699941542
Name:PRATHER, PATRICIA LOU (RD/LD)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:LOU
Last Name:PRATHER
Suffix:
Gender:F
Credentials:RD/LD
Other - Prefix:
Other - First Name:PATSY
Other - Middle Name:
Other - Last Name:PRATHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD/LD
Mailing Address - Street 1:RR 1 BOX 115
Mailing Address - Street 2:12373 N 1740 RD
Mailing Address - City:ERICK
Mailing Address - State:OK
Mailing Address - Zip Code:73645-9736
Mailing Address - Country:US
Mailing Address - Phone:580-526-3024
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 115
Practice Address - Street 2:12373 N 1740 RD
Practice Address - City:ERICK
Practice Address - State:OK
Practice Address - Zip Code:73645-9736
Practice Address - Country:US
Practice Address - Phone:580-526-3024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLD43133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered