Provider Demographics
NPI:1255861902
Name:DIETZ, KATHRYN M (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:M
Last Name:DIETZ
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-882-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-882-6955
Practice Address - Fax:573-884-0437
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2022-10-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2017019767363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant