Provider Demographics
NPI:1841881596
Name:SRADER, DIANE GAIL
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:GAIL
Last Name:SRADER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51800
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79159-1800
Mailing Address - Country:US
Mailing Address - Phone:806-355-9447
Mailing Address - Fax:844-251-2526
Practice Address - Street 1:1900 MEDI PARK DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2187
Practice Address - Country:US
Practice Address - Phone:806-355-9447
Practice Address - Fax:844-251-2526
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143946363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX423509501Medicaid