Healthcare Provider Details

I. General information

NPI: 1669623617
Provider Name (Legal Business Name): DAYNA LYNN PEACOCK RCP,RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAYNA LYNN GLIMP-PEACOCK RCP

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 10/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 E CHERRY ST
CUSHING OK
74023-4105
US

IV. Provider business mailing address

6767 S YALE AVE SUITE B
TULSA OK
74136-3302
US

V. Phone/Fax

Practice location:
  • Phone: 918-225-8208
  • Fax: 918-225-8209
Mailing address:
  • Phone: 918-488-9992
  • Fax: 918-488-9993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number2490
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code2279P1005X
TaxonomyPulmonary Rehabilitation Registered Respiratory Therapist
License Number2490
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: