Provider Demographics
NPI:1558002998
Name:DIMACHKIE, DENA CATHERINE (PA)
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:CATHERINE
Last Name:DIMACHKIE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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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:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:7115 E SAINT CHARLES RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-0196
Practice Address - Country:US
Practice Address - Phone:573-884-6851
Practice Address - Fax:573-884-0293
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2022005470363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant