1912013988 NPI number — DIANE RUTH ELBERS KEAHEY DNP APRN FNP-BC

Table of content: DIANE RUTH ELBERS KEAHEY DNP APRN FNP-BC (NPI 1912013988)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912013988 NPI number — DIANE RUTH ELBERS KEAHEY DNP APRN FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEAHEY
Provider First Name:
DIANE
Provider Middle Name:
RUTH ELBERS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DNP APRN FNP-BC
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:
1912013988
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3415 N HERITAGE PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHERMAN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75092
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-308-3717
Provider Business Mailing Address Fax Number:
903-771-4541

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3415 N HERITAGE PARKWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHERMAN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75092-7509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-308-4336
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/22/2006

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: 363LF0000X , with the licence number:  AP112321 , 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: 0377865 . This is a "ANCC CERTIFICATION NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: AP112321 . This is a "TEXAS APN LICENCE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00729369 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 161061 . This is a "SUPERIOR HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 168082903 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200457760A . This is a "OKLAHOMA SOONER CARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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