Charles Randolph Hewitt III
Dietitian, Registered, Nutrition, Sports Dietetics in Apo, AA. Individual provider (NPI-1).
NPI number1316612906
StatusActive
Last updated in NPPESAug 16, 2021
Details
- NPI
- 1316612906
- Entity type
- Individual (NPI-1)
- Name
- Charles Randolph Hewitt III
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Aug 16, 2021
- Certification date
- Jul 21, 2021
- Last updated
- Aug 16, 2021
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 133VN1501X | Dietitian, Registered, Nutrition, Sports Dietetics | 2021 | OK | Yes |
Practice location
71 Medical GroupApo, AA 73705
Phone 580-213-6751
Mailing address
1517 S Ashton AveStillwater, OK 74074-1877
Phone 281-633-1579
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