Provider Demographics
NPI:1720025430
Name:CUNNINGHAM, DIANE W (RN, BC, FNP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:W
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:RN, BC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Mailing Address - Country:US
Mailing Address - Phone:816-502-7117
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:4330 WORNALL RD
Practice Address - Street 2:SUITE 2000
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5939
Practice Address - Country:US
Practice Address - Phone:816-931-1883
Practice Address - Fax:816-756-3645
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO76727363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP00842718OtherRAILROAD MEDICARE
MOP00836077OtherRAILROAD MEDICARE
KS200003120CMedicaid
MO429425408Medicaid
KS200003120AMedicaid
KS200003120DMedicaid
MOMA2492009Medicare PIN
KSKA1724043Medicare PIN
KSP00842718OtherRAILROAD MEDICARE
KS200003120DMedicaid
MOMA2491009Medicare PIN