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NPI Code Detail

MEDICARE: DR. DIANNA LYNN HICKMAN M.D.

MEDICARE: DR. DIANNA LYNN HICKMAN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist107834MO
2207VX0000XObstetrics PhysicianG03803MO

General Provider Information

NPI Number : 1417956897
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DIANNA LYNN HICKMAN M.D.
Provider Business Mailing Address
First Line : 901 E 104TH ST
Second Line : MAILSTOP 400S
City : KANSAS CITY
State : MO
Zip : 64131-4517
Country : US
Telephone Number : 816-599-9499
Fax Number : 816-932-9670
Provider Business Practice Location Address
First Line : 4401 WORNALL RD
Second Line :
City : KANSAS CITY
State : MO
Zip : 64111-3220
Country : US
Telephone Number : 816-932-3584
Fax Number : 813-932-5873
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2005
Last Update Date : 03/17/2017

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