1295814044 NPI number — MRS. DIANE E YEARY ANP

Table of content: MRS. DIANE E YEARY ANP (NPI 1295814044)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295814044 NPI number — MRS. DIANE E YEARY ANP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YEARY
Provider First Name:
DIANE
Provider Middle Name:
E
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ANP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295814044
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/01/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1389 MCCONNELL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GUNTER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75058-3101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-433-2275
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
425 N HIGHLAND
Provider Second Line Business Practice Location Address:
# 130
Provider Business Practice Location Address City Name:
SHERMAN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75092-7383
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-892-9179
Provider Business Practice Location Address Fax Number:
903-868-2317
Provider Enumeration Date:
11/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  522791 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LG0600X , with the licence number: 522791 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)