Diana Moree Burdick, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

056572 Issued in MO

Practice address

102 North Fisher
Versailles, MO 65084

Phone

(573) 378-2349

Fax

(573) 376-2350

NPI assigned

Mar 28, 2007

Last updated

Oct 19, 2010By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mrs. Diana Moree Stout Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Citizens for Health and Wellness

  • Family Medicine Physician
  • Versailles, MO
  • NPI 1477862936
  NPD (past)

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287446400000",
    "number": "1558480640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 NORTH FISHER",
            "city": "VERSAILLES",
            "state": "MO",
            "postal_code": "65084",
            "telephone_number": "573-378-2349",
            "fax_number": "573-376-2350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 NORTH FISHER",
            "city": "VERSAILLES",
            "state": "MO",
            "postal_code": "65084",
            "telephone_number": "573-378-2349",
            "fax_number": "573-376-2350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURDICK",
        "first_name": "DIANA",
        "middle_name": "MOREE",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-28",
        "last_updated": "2010-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "056572",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "423630409",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DIANA",
            "last_name": "STOUT",
            "middle_name": "MOREE",
            "prefix": "MRS.",
            "credential": "FNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Matthew Bell
• Renae M Belt, LMSW
• Brookside Casa Isl
• Madison Brown
• Jennifer Dawn Buckingham, FNP-C
• Susan Mary Burkhart, M.D.
• Leanne I Cain, RPH
• Capital Region Medical Center (Capital Region Physicians - Versailles)
• Jeffrey S Carver, FNP
• Kihoon Cho, PHARMD.

• Family Nurse Practitioner in Versailles, MO
• Providers in Versailles, MO by specialty
• Family Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2010; 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.