Provider Demographics
NPI:1902800600
Name:GORDON, DIANA L (NP, RN, LPC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:L
Last Name:GORDON
Suffix:
Gender:F
Credentials:NP, RN, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7920 CONSER ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-3460
Mailing Address - Country:US
Mailing Address - Phone:913-221-0750
Mailing Address - Fax:913-221-0751
Practice Address - Street 1:7920 CONSER ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-3460
Practice Address - Country:US
Practice Address - Phone:913-221-0750
Practice Address - Fax:913-221-0751
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO06917163WG0000X
MOC5002565363LP0808X
KS53-75415-021363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health