Provider Demographics
NPI:1700353539
Name:DIAMOND, RICHARD JACK (CRNP)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:JACK
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2753 BENJAMIN FRANKLIN HWY
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16116-4405
Mailing Address - Country:US
Mailing Address - Phone:724-851-5312
Mailing Address - Fax:
Practice Address - Street 1:2580 CONSTITUTION BLVD
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-1294
Practice Address - Country:US
Practice Address - Phone:724-770-7999
Practice Address - Fax:724-843-1514
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-30
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP019508363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty