Provider Demographics
NPI:1922724822
Name:DIECKMEYER, EMILY LENAE (PA-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:LENAE
Last Name:DIECKMEYER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:EMERSYN
Other - Middle Name:LENAE
Other - Last Name:DIECKMEYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:4501 SWISS AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-7119
Mailing Address - Country:US
Mailing Address - Phone:214-820-8700
Mailing Address - Fax:214-818-8707
Practice Address - Street 1:4501 SWISS AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-7119
Practice Address - Country:US
Practice Address - Phone:214-820-8700
Practice Address - Fax:214-818-8707
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical