Provider Demographics
NPI:1164441473
Name:KOTTKEY, DIANA L (NP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:L
Last Name:KOTTKEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:L
Other - Last Name:KOTTKEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:215 10TH ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-1912
Mailing Address - Country:US
Mailing Address - Phone:208-799-3100
Mailing Address - Fax:208-799-0349
Practice Address - Street 1:215 10TH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-1912
Practice Address - Country:US
Practice Address - Phone:208-799-3100
Practice Address - Fax:208-799-0349
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP152A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDMK0371221OtherDEA NUMBER
IDR37124Medicare UPIN