Provider Demographics
NPI:1306115993
Name:ROWE, DIANE KAY (MSN-FNP-C)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:KAY
Last Name:ROWE
Suffix:
Gender:F
Credentials:MSN-FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4822 KINGSWOOD LANE
Mailing Address - Street 2:
Mailing Address - City:DIAMOND
Mailing Address - State:MO
Mailing Address - Zip Code:64840
Mailing Address - Country:US
Mailing Address - Phone:417-206-9939
Mailing Address - Fax:
Practice Address - Street 1:1002 MCINTOSH CIR
Practice Address - Street 2:SUITE 6
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3642
Practice Address - Country:US
Practice Address - Phone:417-781-0250
Practice Address - Fax:417-781-2581
Is Sole Proprietor?:No
Enumeration Date:2011-12-28
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011040129363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily