Provider Demographics
NPI:1326307018
Name:KILBRIDE, DIANE M (APRN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:KILBRIDE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101 HOSPITAL BLVD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130
Mailing Address - Country:US
Mailing Address - Phone:812-282-3899
Mailing Address - Fax:812-282-4172
Practice Address - Street 1:3900 KRESGE WAY
Practice Address - Street 2:SUITE 40
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4660
Practice Address - Country:US
Practice Address - Phone:502-897-7172
Practice Address - Fax:812-282-4172
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71004179A363L00000X
KY3007416363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK055960Medicare PIN
IN122620004Medicare PIN