Provider Demographics
NPI:1225740285
Name:MOORE, DIANA LYNNE
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNNE
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:LYNNE
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12509 W 52ND TER
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216-1459
Mailing Address - Country:US
Mailing Address - Phone:913-206-3909
Mailing Address - Fax:
Practice Address - Street 1:7415 GRANDVIEW ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-1796
Practice Address - Country:US
Practice Address - Phone:913-676-2253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician