Jean Youngstrom Diebolt, RN FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

221153 Issued in TX

Practice address

157 Wall St
Tenaha, TX 75974-5413

Phone

(936) 248-4673

Fax

(936) 248-4646

NPI assigned

Aug 14, 2006

Last updated

Dec 23, 2010By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Registered Nurse

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Health Opportunities for the People of East Texas

  • Family Nurse Practitioner
  • Tenaha, TX
  • NPI 1578779658
  NPD (past) Authorized official
• Health Opportunities for the People of East Texas, Inc.

  • Rural Health Clinic/Center
  • Tenaha, TX
  • NPI 1356468300
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1293062400000",
    "number": "1487667143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1584",
            "city": "CENTER",
            "state": "TX",
            "postal_code": "759351584",
            "telephone_number": "936-248-4673",
            "fax_number": "936-248-4646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "157 WALL ST",
            "city": "TENAHA",
            "state": "TX",
            "postal_code": "759745413",
            "telephone_number": "936-248-4673",
            "fax_number": "936-248-4646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIEBOLT",
        "first_name": "JEAN",
        "middle_name": "YOUNGSTROM",
        "credential": "RN FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-14",
        "last_updated": "2010-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "221153",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "164735601",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carolyn H Burnett, LCSW
• Anita Gale Cartwright
• Christian Love PHC, LLC
• Christian Love Private Home Care, LLC
• Day to Day Medical Transportation
• Destiny Paige Doggett
• Melanie Brooke Farmer, LVN
• Marache Floyd
• Janet Marie Haney, RN FNP-BC
• Health Opportunities for the People of East Texas

• Family Nurse Practitioner in Tenaha, TX
• Providers in Tenaha, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.