Provider Demographics
NPI:1124659164
Name:DIANA L. CORLEY, FNP, LLC
Entity type:Organization
Organization Name:DIANA L. CORLEY, FNP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORLEY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:318-409-4125
Mailing Address - Street 1:117 CANNONBALL DR
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-9401
Mailing Address - Country:US
Mailing Address - Phone:318-623-9578
Mailing Address - Fax:318-625-0683
Practice Address - Street 1:1015 HWY 107
Practice Address - Street 2:
Practice Address - City:CENTERPOINT
Practice Address - State:LA
Practice Address - Zip Code:71323
Practice Address - Country:US
Practice Address - Phone:318-623-9578
Practice Address - Fax:318-625-0683
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIANA L. CORLEY, FNP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-29
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2319213Medicaid