Healthcare Provider Details

I. General information

NPI: 1659032985
Provider Name (Legal Business Name): YEDIDYA K DEAR MSN, APRN, CRNP, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DIDDY DEAR

II. Dates (important events)

Enumeration Date: 01/08/2022
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2909 S HAMPTON RD # D107
DALLAS TX
75224-3000
US

IV. Provider business mailing address

PO BOX 795801
DALLAS TX
75379-5801
US

V. Phone/Fax

Practice location:
  • Phone: 214-467-3832
  • Fax: 972-521-6986
Mailing address:
  • Phone: 469-718-9110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1065937
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number1065937
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number292904
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1065937
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: