Provider Demographics
NPI:1376586891
Name:MARSHALL, DIANA K (PA)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:K
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:KS
Mailing Address - Zip Code:66725-1276
Mailing Address - Country:US
Mailing Address - Phone:620-429-3636
Mailing Address - Fax:620-429-1301
Practice Address - Street 1:101 W SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:KS
Practice Address - Zip Code:66725-1276
Practice Address - Country:US
Practice Address - Phone:620-429-3636
Practice Address - Fax:620-429-1301
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00487363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1376586891OtherBLUE CROSS
KS100349810HMedicaid
KS100349810HMedicaid
KS1376586891OtherBLUE CROSS