Active NPI
Diettra Yvonne Edwards, CBHCM
- Social Worker
- Oklahoma City, OK
National Provider Identifier
1144525825
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 23156
- Practice address
- 301 NW 63Rd St
Suite 140
Oklahoma City, OK 73116-7907 - Phone
- (405) 639-2080
- Fax
- (405) 639-3077
- NPI assigned
- Jan 11, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 23156 | OK | Primary |
Addresses
Primary practice location
301 NW 63Rd St
Suite 140
Oklahoma City, OK 73116-7907
Mailing address
301 NW 63Rd St
Suite 140
Oklahoma City, OK 73116-7907
Phone (405) 639-2080
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23156 | OK | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1294704000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1294704000000",
"number": "1144525825",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 NW 63RD ST",
"address_2": "SUITE 140",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731167907",
"telephone_number": "405-639-2080",
"fax_number": "405-639-3077"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 NW 63RD ST",
"address_2": "SUITE 140",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731167907",
"telephone_number": "405-639-2080",
"fax_number": "405-639-3077"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDWARDS",
"first_name": "DIETTRA",
"middle_name": "YVONNE",
"credential": "CBHCM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-01-11",
"last_updated": "2011-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "OK",
"license": "23156",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.