Provider Demographics
NPI:1912013988
Name:KEAHEY, DIANE RUTH ELBERS (DNP APRN FNP-BC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:RUTH ELBERS
Last Name:KEAHEY
Suffix:
Gender:F
Credentials:DNP APRN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 N HERITAGE PKWY
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092
Mailing Address - Country:US
Mailing Address - Phone:903-308-3717
Mailing Address - Fax:903-771-4541
Practice Address - Street 1:3415 N HERITAGE PARKWAY
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7509
Practice Address - Country:US
Practice Address - Phone:903-308-4336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP112321363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0377865OtherANCC CERTIFICATION NUMBER
TXAP112321OtherTEXAS APN LICENCE
TXP00729369OtherMEDICARE RAILROAD
TX161061OtherSUPERIOR HEALTH
TX168082903Medicaid
OK200457760AOtherOKLAHOMA SOONER CARE
OK200457760AOtherOKLAHOMA SOONER CARE
TX168082903Medicaid