Provider Demographics
NPI:1316736424
Name:PREMIER PANORAMA PSYCHIATRY PLLC
Entity type:Organization
Organization Name:PREMIER PANORAMA PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:I
Authorized Official - Last Name:RICKETTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-336-1943
Mailing Address - Street 1:1601 E LAMAR BLVD STE 214
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-4464
Mailing Address - Country:US
Mailing Address - Phone:682-336-1943
Mailing Address - Fax:682-316-9194
Practice Address - Street 1:1601 E LAMAR BLVD STE 214
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-4464
Practice Address - Country:US
Practice Address - Phone:682-336-1943
Practice Address - Fax:682-316-9194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty