Healthcare Provider Details

I. General information

NPI: 1053235226
Provider Name (Legal Business Name): DIANA RENA KATES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DIANA SWAFFORD

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 S PHILLIPS AVE
OKLAHOMA CITY OK
73129-4458
US

IV. Provider business mailing address

1670 S PHILLIPS AVE
OKLAHOMA CITY OK
73129-4458
US

V. Phone/Fax

Practice location:
  • Phone: 405-780-1480
  • Fax:
Mailing address:
  • Phone: 405-780-1480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: