| Doctor Name: | MRS. DIANA KOFRON |
| NPI Number: | 1386075794 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CPNP |
| License Number: | 2013043971 |
| Business Practice Address: | 7050 Air Depot Blvd 72 Mdg/sgoc Tinker Afb, OK - 731458716 |
| Business Phone Number: | 4055826168 |
| Business Fax Number: | 4057363175 |
| Mailing Address: | 8324 Canyon Trail Dr, OKLAHOMA CITY |
| State: | OK |
| Postal Code: | 731356240 |
| Phone Number: | 4055826168 |
| Fax Number: | 4057363175 |
| NPI Enumeration Date: | 12/11/2013 |
| NPI Last Update Date: | 12/11/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 2013043971 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |