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General NPI Number Information
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NPI Number | 1053296129
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Entity Type | Organization
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Legal Business Name | OKLAHOMA ADVANCED DIABETES CARE PLLC
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Dates
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Enumeration Date | 08/07/2025
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 1016 24TH AVE NW STE 110
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City | NORMAN
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State | OK
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Zip | 73069-6542
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Country | US
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Telephone | 405-467-2280
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Fax |
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Provider Business Mailing Address
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Address Line | 1016 24TH AVE NW STE 110
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City | NORMAN
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State | OK
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Zip | 73069-6542
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Country | US
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Telephone | 405-467-2280
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGING MEMBER
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Name | STEPHANIE PORTER
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Credential | PA-C
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Telephone | 405-467-2280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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