Provider Demographics
NPI:1427869601
Name:DIEDIKER, KARLIE (ACNP)
Entity type:Individual
Prefix:
First Name:KARLIE
Middle Name:
Last Name:DIEDIKER
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:KARLIE
Other - Middle Name:
Other - Last Name:VAIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP
Mailing Address - Street 1:1970 MEADE RD
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:KS
Mailing Address - Zip Code:67357-7618
Mailing Address - Country:US
Mailing Address - Phone:620-330-3109
Mailing Address - Fax:
Practice Address - Street 1:100 MERCY WAY
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4524
Practice Address - Country:US
Practice Address - Phone:417-781-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-82487-022363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care