Provider Demographics
NPI:1235193103
Name:GUESS, DIETTA L (APRN)
Entity Type:Individual
Prefix:
First Name:DIETTA
Middle Name:L
Last Name:GUESS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:DIETTA
Other - Middle Name:L
Other - Last Name:GUESS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:713 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:KY
Mailing Address - Zip Code:42220-9229
Mailing Address - Country:US
Mailing Address - Phone:270-265-5353
Mailing Address - Fax:270-265-5350
Practice Address - Street 1:713 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:KY
Practice Address - Zip Code:42220-9229
Practice Address - Country:US
Practice Address - Phone:270-265-5353
Practice Address - Fax:270-265-5350
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2151P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78008745Medicaid
KY78008745Medicaid