Provider Demographics
NPI:1487112728
Name:HARDESTY, DIANA LOUISE (NP)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:LOUISE
Last Name:HARDESTY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 CLARENDON RD
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-6712
Mailing Address - Country:US
Mailing Address - Phone:660-473-0157
Mailing Address - Fax:
Practice Address - Street 1:2600 CLARENDON RD
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-6712
Practice Address - Country:US
Practice Address - Phone:660-473-0157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-78437-112363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily