Provider Demographics
NPI:1174827760
Name:PATTERSON, DIANA GADDY (PAC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:GADDY
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 RICKETY LN
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-1706
Mailing Address - Country:US
Mailing Address - Phone:903-533-8811
Mailing Address - Fax:903-593-5511
Practice Address - Street 1:2017 RICKETY LN
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1706
Practice Address - Country:US
Practice Address - Phone:903-533-8811
Practice Address - Fax:903-593-5511
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06919363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant