Healthcare Provider Details

I. General information

NPI: 1235053687
Provider Name (Legal Business Name): KATIE DIAMOND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

U.S. ARMY HEALTH CLINIC VILSECK UNIT 23807
APO AE
09112
US

IV. Provider business mailing address

UNIT 28307 MEDDAC-B BUILDING 700, ROOM 109
APO AE
09112-8037
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-2300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number95209385
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: