Provider Demographics
NPI:1952474108
Name:DIANA, KAREN (APRN)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:DIANA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 S 24TH AVE STE B
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-5720
Mailing Address - Country:US
Mailing Address - Phone:509-996-5881
Mailing Address - Fax:509-844-9597
Practice Address - Street 1:1705 S 24TH AVE STE B
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-5720
Practice Address - Country:US
Practice Address - Phone:509-996-5881
Practice Address - Fax:509-844-9597
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60536346363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1952474108Medicaid
TN4116887OtherBCBS TN
WA1952474108Medicaid
TN4116887OtherBCBS TN
TN3387193Medicaid
WAG8940394Medicare PIN