Healthcare Provider Details

I. General information

NPI: 1659206654
Provider Name (Legal Business Name): DIANE RENEE MCCASLIN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 N STOCKTON HILL RD STE 101
KINGMAN AZ
86401-6232
US

IV. Provider business mailing address

1115 N STOCKTON HILL RD STE 101
KINGMAN AZ
86401-6232
US

V. Phone/Fax

Practice location:
  • Phone: 928-263-1481
  • Fax:
Mailing address:
  • Phone: 928-263-1481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number283012
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: