Healthcare Provider Details

I. General information

NPI: 1669300075
Provider Name (Legal Business Name): DIAMOND WILBURN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 S AIR DEPOT BLVD
MIDWEST CITY OK
73110-5103
US

IV. Provider business mailing address

2700 TIMMONS DR APT 7
MIDWEST CITY OK
73110-7548
US

V. Phone/Fax

Practice location:
  • Phone: 405-622-4239
  • Fax:
Mailing address:
  • Phone: 405-458-2981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number26-536659
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: