1447514831 NPI number — DIANA MARGARET KEDORA FNP

Table of content: DIANA MARGARET KEDORA FNP (NPI 1447514831)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447514831 NPI number — DIANA MARGARET KEDORA FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEDORA
Provider First Name:
DIANA
Provider Middle Name:
MARGARET
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
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:
1447514831
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4708 ALLIANCE BLVD
Provider Second Line Business Mailing Address:
PAVILION I, SUITE 300
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75093-5340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-758-6000
Provider Business Mailing Address Fax Number:
972-758-6001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4708 ALLIANCE BLVD
Provider Second Line Business Practice Location Address:
PAVILION I, SUITE 300
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75093-5340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-758-6000
Provider Business Practice Location Address Fax Number:
972-758-6001
Provider Enumeration Date:
06/29/2012

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: 363LF0000X , with the licence number:  684355 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 306149101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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