MEDICARE: KEYDY DIAZ FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP130843	TX

General Provider Information

NPI Number	:	1972950384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEYDY DIAZ FNP-C

Provider Business Mailing Address
First Line	:	11511 SHADOW CREEK PKWY
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-7298
Country	:	US
Telephone Number	:	713-442-0000
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 N SAM HOUSTON PKWY W STE 650
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77067-4336
Country	:	US
Telephone Number	:	816-544-5002
Fax Number	:	281-654-4501

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2016
Last Update Date	:	12/29/2025

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Directions to “ KEYDY DIAZ FNP-C” Practice Location

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