Provider Demographics
NPI:1073930780
Name:WALKER, DIANNA (NP)
Entity type:Individual
Prefix:
First Name:DIANNA
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DIANNA
Other - Middle Name:J
Other - Last Name:GAFFNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 419052
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-9052
Mailing Address - Country:US
Mailing Address - Phone:314-543-5200
Mailing Address - Fax:314-543-5219
Practice Address - Street 1:3555 SUNSET OFFICE DR STE 107
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1045
Practice Address - Country:US
Practice Address - Phone:314-543-5200
Practice Address - Fax:314-543-5219
Is Sole Proprietor?:No
Enumeration Date:2014-03-20
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014005735363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA3925004Medicare PIN