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General NPI Number Information
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NPI Number | 1306520812
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Entity Type | Individual
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Provider Name | KAYDIE ANN DIAL FNP
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Gender | Female
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Dates
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Enumeration Date | 06/14/2023
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 304A E 4TH ST
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City | ELDON
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State | MO
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Zip | 65026-1808
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Country | US
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Telephone | 573-392-5654
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Fax |
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Provider Business Mailing Address
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Address Line | 54 HOSPITAL DR
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City | OSAGE BEACH
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State | MO
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Zip | 65065-3050
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Country | US
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Telephone | 573-348-8000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2023017586
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License Number State | MO
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