Provider Demographics
NPI:1285220723
Name:PHELPS, DIANA LINDA (APRN)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LINDA
Last Name:PHELPS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2157 S HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:STEARNS
Mailing Address - State:KY
Mailing Address - Zip Code:42647-6297
Mailing Address - Country:US
Mailing Address - Phone:606-416-5719
Mailing Address - Fax:
Practice Address - Street 1:2157 S HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:STEARNS
Practice Address - State:KY
Practice Address - Zip Code:42647-6297
Practice Address - Country:US
Practice Address - Phone:606-376-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015225363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily