Provider Demographics
NPI:1841900180
Name:FARLEY, DEANNA (NP)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:FARLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14100 SAN PEDRO AVE STE 412
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-2009
Mailing Address - Country:US
Mailing Address - Phone:210-281-8669
Mailing Address - Fax:
Practice Address - Street 1:15069 IH 35 N STE 116
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:TX
Practice Address - Zip Code:78154-3372
Practice Address - Country:US
Practice Address - Phone:210-656-4878
Practice Address - Fax:210-745-0562
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX829803163W00000X, 207RA0000X
TX1099960363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine