Provider Demographics
NPI:1427858919
Name:DIEFENBAUGH, MISTI
Entity type:Individual
Prefix:
First Name:MISTI
Middle Name:
Last Name:DIEFENBAUGH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 142
Mailing Address - Street 2:
Mailing Address - City:MERNA
Mailing Address - State:NE
Mailing Address - Zip Code:68856-0142
Mailing Address - Country:US
Mailing Address - Phone:208-403-4537
Mailing Address - Fax:
Practice Address - Street 1:24 W 16TH ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-6058
Practice Address - Country:US
Practice Address - Phone:308-865-5361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care