Provider Demographics
NPI:1144820127
Name:KESSLER, DIANNE ELAINE
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:ELAINE
Last Name:KESSLER
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:DIANNE
Other - Middle Name:ELAINE
Other - Last Name:KESSLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPH
Mailing Address - Street 1:6437 N MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-6503
Mailing Address - Country:US
Mailing Address - Phone:405-495-1040
Mailing Address - Fax:405-495-1073
Practice Address - Street 1:6437 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-6503
Practice Address - Country:US
Practice Address - Phone:405-495-1040
Practice Address - Fax:405-495-1073
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11106183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist