Provider Demographics
NPI:1063251825
Name:JOHNSON, DIANE ANNETTE ROBISON (RD)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:ANNETTE ROBISON
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 W 128TH ST S
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-4410
Mailing Address - Country:US
Mailing Address - Phone:314-606-7090
Mailing Address - Fax:
Practice Address - Street 1:2139 E 21ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-1409
Practice Address - Country:US
Practice Address - Phone:314-606-7090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-22
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2969133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered