Healthcare Provider Details

I. General information

NPI: 1235165697
Provider Name (Legal Business Name): DIANE C LLOYD ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 03/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 NW 3RD ST
ANDREWS TX
79714-5014
US

IV. Provider business mailing address

1305 NW 16TH ST
ANDREWS TX
79714-2601
US

V. Phone/Fax

Practice location:
  • Phone: 432-523-3640
  • Fax: 432-524-1973
Mailing address:
  • Phone: 575-318-9694
  • Fax: 432-524-1973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number175
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: