Active NPI
Diana Lynn Wallace, R.D. L.D.
- Registered Dietitian
- Tulsa, OK
National Provider Identifier
1497837645
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 587
- Practice address
- 8086 S Yale Ave
Ste. 184
Tulsa, OK 74136-9003 - Phone
- (918) 691-5768
- NPI assigned
- Oct 19, 2006
- 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 587 | OK | Primary |
Addresses
Primary practice location
8086 S Yale Ave
Ste. 184
Tulsa, OK 74136-9003
Mailing address
8086 S Yale Ave
Ste. 184
Tulsa, OK 74136-9003
Phone (918) 691-5768
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 587 | OK | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1497837645",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8086 S YALE AVE",
"address_2": "STE. 184",
"city": "TULSA",
"state": "OK",
"postal_code": "741369003",
"telephone_number": "918-691-5768"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8086 S YALE AVE",
"address_2": "STE. 184",
"city": "TULSA",
"state": "OK",
"postal_code": "741369003",
"telephone_number": "918-691-5768"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "DIANA",
"middle_name": "LYNN",
"name_prefix": "Ms.",
"credential": "R.D. L.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "OK",
"license": "587",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tulsa, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.