Provider Demographics
NPI:1861140576
Name:GLEGHORN, DIAMOND MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:DIAMOND
Middle Name:MARIE
Last Name:GLEGHORN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DIAMOND
Other - Middle Name:MARIE
Other - Last Name:URBANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9323 S DARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-4402
Mailing Address - Country:US
Mailing Address - Phone:918-814-8326
Mailing Address - Fax:
Practice Address - Street 1:1717 S UTICA AVE STE A
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5346
Practice Address - Country:US
Practice Address - Phone:918-748-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-11
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical