Provider Demographics
NPI:1235413071
Name:DIETRICH, JOHN WARNER (FNP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WARNER
Last Name:DIETRICH
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 NE BARRY RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-2724
Mailing Address - Country:US
Mailing Address - Phone:785-969-2304
Mailing Address - Fax:
Practice Address - Street 1:330 NE BARRY RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155-2724
Practice Address - Country:US
Practice Address - Phone:785-969-2304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-75495-082363LF0000X
MO2011034132363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily