Provider Demographics
NPI:1366452195
Name:HAYSLIP, DIANA C (MD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:C
Last Name:HAYSLIP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 ALYSHEBA WAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-9023
Mailing Address - Country:US
Mailing Address - Phone:859-278-5007
Mailing Address - Fax:859-278-6867
Practice Address - Street 1:1775 ALYSHEBA WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-9023
Practice Address - Country:US
Practice Address - Phone:859-278-5007
Practice Address - Fax:859-278-6867
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY41066207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100014930Medicaid
H91373Medicare UPIN
KY7100014930Medicaid