Provider Demographics
NPI:1962863704
Name:SIMPSON, FELICIA (MPPD, RD/LD)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:MPPD, RD/LD
Other - Prefix:
Other - First Name:FELICIA
Other - Middle Name:
Other - Last Name:WATKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17056 W 782 RD
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-7379
Mailing Address - Country:US
Mailing Address - Phone:918-822-0245
Mailing Address - Fax:
Practice Address - Street 1:100 S BLISS AVE
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-2512
Practice Address - Country:US
Practice Address - Phone:918-458-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered