Provider Demographics
NPI:1770135527
Name:WILEMON, DIANA FLURRY (FNP)
Entity type:Individual
Prefix:MS
First Name:DIANA
Middle Name:FLURRY
Last Name:WILEMON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:DIANA
Other - Middle Name:CATHERINE
Other - Last Name:FLURRY-WILEMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:3414 MILTON AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-1338
Mailing Address - Country:US
Mailing Address - Phone:463-522-3995
Mailing Address - Fax:972-364-1925
Practice Address - Street 1:3414 MILTON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-1338
Practice Address - Country:US
Practice Address - Phone:469-522-3995
Practice Address - Fax:972-364-1925
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142158363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily