Diandra Brigette Kissack

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

721 N Pines Rd
Spokane Valley, WA 99206-5225

Phone

(509) 892-1100

NPI assigned

Mar 15, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1552608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706745600000",
    "number": "1205395688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "721 S HENRY RD",
            "city": "GREENACRES",
            "state": "WA",
            "postal_code": "990169617",
            "telephone_number": "509-953-2928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 N PINES RD",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992065225",
            "telephone_number": "509-892-1100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "721 S Henry Rd",
            "address_purpose": "LOCATION",
            "city": "Greenacres",
            "state": "WA",
            "postal_code": "990169617",
            "country_code": "US",
            "telephone_number": "509-953-2928",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KISSACK",
        "first_name": "DIANDRA",
        "middle_name": "BRIGETTE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-15",
        "last_updated": "2024-02-01",
        "certification_date": "2024-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Felix Kigen Kipchirchir
• Anna Ignatyevna Kirichenko
• Kirk Fuhriman PLLC (Childrens Dental Village)
• Angela Ariela Kisel, NP
• Nicole Kiser
• Amanda Kistler, D.D.S.
• Nicholas Kitson
• Michelle Klein Phay
• Shayla Klein
• Stefon Kleinert

• Student in an Organized Health Care Education/Training Program in Spokane Valley, WA
• Providers in Spokane Valley, WA by specialty
• Student in an Organized Health Care Education/Training Program in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.