Provider Demographics
NPI:1053296129
Name:OKLAHOMA ADVANCED DIABETES CARE PLLC
Entity type:Organization
Organization Name:OKLAHOMA ADVANCED DIABETES CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:405-467-2280
Mailing Address - Street 1:1016 24TH AVE NW STE 110
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6542
Mailing Address - Country:US
Mailing Address - Phone:405-467-2280
Mailing Address - Fax:
Practice Address - Street 1:1016 24TH AVE NW STE 110
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6542
Practice Address - Country:US
Practice Address - Phone:405-467-2280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-07
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty