Provider Demographics
NPI:1528263621
Name:REYES, DIKI ANN (FNP)
Entity type:Individual
Prefix:
First Name:DIKI
Middle Name:ANN
Last Name:REYES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DIKI
Other - Middle Name:ANN
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1342 W GOODWIN ST
Mailing Address - Street 2:P.O. BOX7
Mailing Address - City:PLEASANTON
Mailing Address - State:TX
Mailing Address - Zip Code:78064-3900
Mailing Address - Country:US
Mailing Address - Phone:830-569-0051
Mailing Address - Fax:830-569-0083
Practice Address - Street 1:1342 W GOODWIN ST
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:TX
Practice Address - Zip Code:78064-3900
Practice Address - Country:US
Practice Address - Phone:830-569-0051
Practice Address - Fax:830-569-0083
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2016-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX657871363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB151718Medicare PIN
TXTXB151718Medicare PIN