Provider Demographics
NPI:1972950384
Name:DIAZ, KEYDY (FNP-C)
Entity Type:Individual
Prefix:
First Name:KEYDY
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17045 SAINT EDWARDS DR STE 302
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-1753
Mailing Address - Country:US
Mailing Address - Phone:713-694-6390
Mailing Address - Fax:713-694-5331
Practice Address - Street 1:17045 SAINT EDWARDS DR STE 302
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-1753
Practice Address - Country:US
Practice Address - Phone:713-694-6390
Practice Address - Fax:713-694-5331
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130843363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily