Individual
DIANNA LYNN KIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, AGACNP-BC
Contact information
Practice address
1133 MEDICAL DR, TYLER, TX 75701-2130
(903) 595-5486
(903) 595-5128
Mailing address
1133 MEDICAL DR, TYLER, TX 75701-2130
(903) 595-5486
(903) 595-5128
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
705683
TX
363L00000X
Nurse Practitioner
Primary
AP1097102
TX
363LA2100X
Acute Care Nurse Practitioner
AP1097102
TX
363LG0600X
Gerontology Nurse Practitioner
AP1097102
TX
Other
Enumeration date
10/19/2022
Last updated
07/12/2024
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