Provider Demographics
NPI:1194844738
Name:CLEWETT, DIANA
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:
Last Name:CLEWETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 ABERDEEN DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-1301
Mailing Address - Country:US
Mailing Address - Phone:859-272-4247
Mailing Address - Fax:859-272-0165
Practice Address - Street 1:225 ABERDEEN DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-1301
Practice Address - Country:US
Practice Address - Phone:859-272-4247
Practice Address - Fax:859-272-0165
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY01964OtherPROVIDER ID FOR BILLING