MEDICARE: DIVERSITY HEALTH AND WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	364SH1100X	Holistic Clinical Nurse Specialist
2	363L00000X	Nurse Practitioner
3	207Q00000X	Family Medicine Physician
4	207K00000X	Allergy & Immunology Physician
5	171400000X	Health & Wellness Coach
6	207RA0201X	Allergy & Immunology (Internal Medicine) Physician
7	261Q00000X	Clinic/Center
8	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
9	101YM0800X	Mental Health Counselor
10	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	N083704850	OTHER	OK	TELE HEALTH SERVICES

General Provider Information

NPI Number	:	1790418283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVERSITY HEALTH AND WELLNESS

Provider Business Mailing Address
First Line	:	2831 NE 23RD ST STE B
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73121-2437
Country	:	US
Telephone Number	:	405-252-1178
Fax Number	:

Provider Business Practice Location Address
First Line	:	2831 NE 23RD ST STE B
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73121-2437
Country	:	US
Telephone Number	:	405-252-1178
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHANTELL ROBINSON
Credential	:
Telephone Number	:	405-252-1178

Provider Enumeration Date	:	07/02/2022
Last Update Date	:	04/06/2026

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Directions to “DIVERSITY HEALTH AND WELLNESS ” Practice Location

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