Provider Demographics
NPI:1992345672
Name:SMITH-KENNEY, HEATHER DAWN (LICENSED DIETITIAN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:DAWN
Last Name:SMITH-KENNEY
Suffix:
Gender:F
Credentials:LICENSED DIETITIAN
Other - Prefix:MRS
Other - First Name:HEATHER
Other - Middle Name:DAWN
Other - Last Name:SMITH-KENNEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2321 NW 54TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-7756
Mailing Address - Country:US
Mailing Address - Phone:405-412-6621
Mailing Address - Fax:
Practice Address - Street 1:1000 N LEE AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1036
Practice Address - Country:US
Practice Address - Phone:405-272-7102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1538133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered