JEAN YOUNGSTROM DIEBOLT RN FNP NPI 1487667143

NPI Information

NPI: 1487667143
Provider Name: JEAN YOUNGSTROM DIEBOLT, RN FNP
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

Address:
157 WALL ST
TENAHA, TX
ZIP 75974
Phone: (936) 248-4673
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Jean Youngstrom Diebolt, RN FNP is a family nurse practitioner in Tenaha, TX. Jean Youngstrom Diebolt, RN FNP NPI is 1487667143. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

157 WALL ST
TENAHA, TX
ZIP 75974-413
Phone: (936) 248-4673
Fax: (936) 248-4646

The enumeration date for this NPI number is 8/14/2006 and was last updated on 12/23/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	221153	TEXAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	164735601	MEDICAID	TEXAS
2	S64639	MEDICARE UPIN	TEXAS
3	00904V	MEDICARE ID-TYPE UNSPECIFIED	TEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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