Provider Demographics
NPI:1174033039
Name:PARENT, DIANA LYNN
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:PARENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:LYNN
Other - Last Name:PARENT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DIANA LYNN MARTIN
Mailing Address - Street 1:5310 E 31ST ST STE 7
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-5014
Mailing Address - Country:US
Mailing Address - Phone:918-599-7404
Mailing Address - Fax:918-777-9016
Practice Address - Street 1:2325 S HARVARD AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-3300
Practice Address - Country:US
Practice Address - Phone:918-599-7404
Practice Address - Fax:918-382-1881
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKU080054193175T00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1174033039Medicaid