Provider Demographics
NPI:1669623617
Name:PEACOCK, DAYNA LYNN (RCP,RRT)
Entity type:Individual
Prefix:MRS
First Name:DAYNA
Middle Name:LYNN
Last Name:PEACOCK
Suffix:
Gender:F
Credentials:RCP,RRT
Other - Prefix:MRS
Other - First Name:DAYNA
Other - Middle Name:LYNN
Other - Last Name:GLIMP-PEACOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RCP
Mailing Address - Street 1:6767 S YALE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3302
Mailing Address - Country:US
Mailing Address - Phone:918-488-9992
Mailing Address - Fax:918-488-9993
Practice Address - Street 1:1023 E CHERRY ST
Practice Address - Street 2:
Practice Address - City:CUSHING
Practice Address - State:OK
Practice Address - Zip Code:74023-4105
Practice Address - Country:US
Practice Address - Phone:918-225-8208
Practice Address - Fax:918-225-8209
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2490227900000X, 2279P1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279P1005XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary Rehabilitation
No227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2490OtherOKLAHOMA STATE MEDICAL LICENSE