Provider Demographics
NPI:1326245911
Name:HALLOCK, DIANNE LYNN (FNP)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:LYNN
Last Name:HALLOCK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25955 TRINCHERA RD
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:MO
Mailing Address - Zip Code:65326
Mailing Address - Country:US
Mailing Address - Phone:660-438-5722
Mailing Address - Fax:660-438-5722
Practice Address - Street 1:601 E 14TH ST
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-5972
Practice Address - Country:US
Practice Address - Phone:660-286-8833
Practice Address - Fax:660-827-3742
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006031855363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily