Provider Demographics
NPI:1417956897
Name:HICKMAN, DIANNA LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANNA
Middle Name:LYNN
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LYNN
Other - Middle Name:
Other - Last Name:CARGILL-HICKMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:901 E 104TH ST
Mailing Address - Street 2:MAILSTOP 400S
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4517
Mailing Address - Country:US
Mailing Address - Phone:816-599-9499
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:4401 WORNALL RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3220
Practice Address - Country:US
Practice Address - Phone:816-932-3584
Practice Address - Fax:813-932-5873
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO107834174400000X
MOG03803207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOC03803Medicare UPIN
MOW19000473Medicare PIN