Provider Demographics
NPI:1457393183
Name:DEDMON, DIANA DRUMWRIGHT (FNP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:DRUMWRIGHT
Last Name:DEDMON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5480 GOODMAN RD
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-7902
Mailing Address - Country:US
Mailing Address - Phone:662-893-9800
Mailing Address - Fax:662-893-9827
Practice Address - Street 1:5480 GOODMAN RD
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-7902
Practice Address - Country:US
Practice Address - Phone:662-893-9800
Practice Address - Fax:662-893-9827
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000006640363LF0000X
MSA810524363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3649176Medicaid
TN3649176Medicaid
TNE81377Medicare UPIN