Healthcare Provider Details

I. General information

NPI: 1356345805
Provider Name (Legal Business Name): DIANE A GAUNT ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 11/12/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LIFESTANCE HEALTH 8400 W 110TH STREET SUITE 250
OVERLAND PARK KS
66210-2461
US

IV. Provider business mailing address

8400 W 110TH ST STE 250
OVERLAND PARK KS
66210-2461
US

V. Phone/Fax

Practice location:
  • Phone: 913-210-2019
  • Fax: 913-327-7054
Mailing address:
  • Phone: 913-210-2019
  • Fax: 316-686-6764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number74065
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: