1356345805 NPI number — MS. DIANE A GAUNT ARNP

Table of content: MS. DIANE A GAUNT ARNP (NPI 1356345805)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356345805 NPI number — MS. DIANE A GAUNT ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAUNT
Provider First Name:
DIANE
Provider Middle Name:
A
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356345805
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8400 W 110TH ST STE 250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66210-2461
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-210-2019
Provider Business Mailing Address Fax Number:
316-686-6764

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
LIFESTANCE HEALTH
Provider Second Line Business Practice Location Address:
8400 W 110TH STREET SUITE 250
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66210-2461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-210-2019
Provider Business Practice Location Address Fax Number:
913-327-7054
Provider Enumeration Date:
06/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 364SP0808X , with the licence number:  74065 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100331210A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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