Active NPI
Diana Gaddy Patterson, P.A.C
- Physician Assistant
- Tyler, TX
National Provider Identifier
1174827760
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA06919
- Practice address
- 17791 County Road 15
Tyler, TX 75703-0803 - Phone
- (903) 520-6523
- NPI assigned
- Dec 22, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA06919 | TX | Primary |
Addresses
Primary practice location
17791 County Road 15
Tyler, TX 75703-0803
Mailing address
17791 County Road 15
Tyler, TX 75703-0803
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
- Opted out of Medicare
- Yes, effective Jan 1, 2026 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA06919 | TX | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1292976000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1764028800000",
"number": "1174827760",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17791 COUNTY ROAD 15",
"city": "TYLER",
"state": "TX",
"postal_code": "757030803"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17791 COUNTY ROAD 15",
"city": "TYLER",
"state": "TX",
"postal_code": "757030803",
"telephone_number": "903-520-6523"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PATTERSON",
"first_name": "DIANA",
"middle_name": "GADDY",
"credential": "P.A.C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-12-22",
"last_updated": "2025-11-25",
"certification_date": "2025-11-25",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "PA06919",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.