Healthcare Provider Details

I. General information

NPI: 1922335769
Provider Name (Legal Business Name): DIANNA LYNN PHARES PHD, DNP, APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2009
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4605 CROSSHAVEN CT
WELDON SPRING MO
63304-0500
US

IV. Provider business mailing address

4605 CROSSHAVEN CT
WELDON SPRING MO
63304-0500
US

V. Phone/Fax

Practice location:
  • Phone: 314-503-4052
  • Fax: 636-498-6666
Mailing address:
  • Phone: 314-503-4052
  • Fax: 636-498-6666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number137634
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number137634
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: