Provider Demographics
NPI:1922335769
Name:PHARES, DIANNA LYNN (PHD, DNP, APRN-BC)
Entity Type:Individual
Prefix:DR
First Name:DIANNA
Middle Name:LYNN
Last Name:PHARES
Suffix:
Gender:F
Credentials:PHD, DNP, APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4605 CROSSHAVEN CT
Mailing Address - Street 2:
Mailing Address - City:WELDON SPRING
Mailing Address - State:MO
Mailing Address - Zip Code:63304-0500
Mailing Address - Country:US
Mailing Address - Phone:314-503-4052
Mailing Address - Fax:636-498-6666
Practice Address - Street 1:4605 CROSSHAVEN CT
Practice Address - Street 2:
Practice Address - City:WELDON SPRING
Practice Address - State:MO
Practice Address - Zip Code:63304-0500
Practice Address - Country:US
Practice Address - Phone:314-503-4052
Practice Address - Fax:636-498-6666
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-16
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO137634363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily