Provider Demographics
NPI:1295814044
Name:YEARY, DIANE E (ANP)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:E
Last Name:YEARY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1389 MCCONNELL RD
Mailing Address - Street 2:
Mailing Address - City:GUNTER
Mailing Address - State:TX
Mailing Address - Zip Code:75058-3101
Mailing Address - Country:US
Mailing Address - Phone:903-433-2275
Mailing Address - Fax:
Practice Address - Street 1:425 N HIGHLAND
Practice Address - Street 2:# 130
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7383
Practice Address - Country:US
Practice Address - Phone:903-892-9179
Practice Address - Fax:903-868-2317
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX522791363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86N348Medicare ID - Type Unspecified
TXS50876Medicare UPIN