Provider Demographics
NPI:1922724822
Name:DIECKMEYER, EMILY LENAE (PA-C)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:LENAE
Last Name:DIECKMEYER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:EMERSYN
Other - Middle Name:LENAE
Other - Last Name:DIECKMEYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:2223 HAWES AVE APT 474
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-4617
Mailing Address - Country:US
Mailing Address - Phone:856-701-5414
Mailing Address - Fax:
Practice Address - Street 1:5200 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7709
Practice Address - Country:US
Practice Address - Phone:214-590-8718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical