Provider Demographics
NPI:1962496919
Name:KEMPER, DIANA J (MSN)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:J
Last Name:KEMPER
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6470 N SHADELAND AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-4390
Mailing Address - Country:US
Mailing Address - Phone:317-849-9509
Mailing Address - Fax:317-841-1157
Practice Address - Street 1:6470 N SHADELAND AVE
Practice Address - Street 2:SUITE C
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-4390
Practice Address - Country:US
Practice Address - Phone:317-849-9509
Practice Address - Fax:317-841-1157
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN28049188A364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000079956OtherBLUE CROSS BLUE SHIELD