Provider Demographics
NPI:1154073765
Name:DIANA L KENNEDY,MD INC
Entity Type:Organization
Organization Name:DIANA L KENNEDY,MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:D
Authorized Official - Last Name:CAVAZOS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:405-751-6117
Mailing Address - Street 1:4205 MCAULEY BLVD STE 420
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8347
Mailing Address - Country:US
Mailing Address - Phone:405-751-6117
Mailing Address - Fax:405-751-0479
Practice Address - Street 1:4205 MCAULEY BLVD STE 420
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8347
Practice Address - Country:US
Practice Address - Phone:405-751-6117
Practice Address - Fax:405-751-0479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty