Provider Demographics
NPI:1073990602
Name:CENTRAL OKLAHOMA DIABETES CENTER APRN CNP NP-C PLLC
Entity Type:Organization
Organization Name:CENTRAL OKLAHOMA DIABETES CENTER APRN CNP NP-C PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, CNP
Authorized Official - Phone:405-546-0468
Mailing Address - Street 1:1010 24TH AVE NW
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6494
Mailing Address - Country:US
Mailing Address - Phone:405-801-4050
Mailing Address - Fax:405-701-8988
Practice Address - Street 1:1010 24TH AVE NW
Practice Address - Street 2:SUITE 110
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6494
Practice Address - Country:US
Practice Address - Phone:405-801-4050
Practice Address - Fax:405-701-8988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK76737363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty