Provider Demographics
NPI:1548356173
Name:GARCIA, DIANNA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:DIANNA
Middle Name:MARIE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10402 W 164TH TER
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66221-4537
Mailing Address - Country:US
Mailing Address - Phone:913-486-7226
Mailing Address - Fax:
Practice Address - Street 1:8101 W 135TH ST STE 200
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-1111
Practice Address - Country:US
Practice Address - Phone:913-491-3999
Practice Address - Fax:913-491-9309
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1501143363AM0700X
TXPA02108363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200591990AMedicaid
TXP01815Medicare UPIN
KS200591990AMedicaid