Provider Demographics
NPI:1407598048
Name:BROSIUS, DIANA KATHLEEN (MSN, APRN, PMHNP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:KATHLEEN
Last Name:BROSIUS
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:946A SOUTHERN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-3410
Mailing Address - Country:US
Mailing Address - Phone:859-582-9897
Mailing Address - Fax:
Practice Address - Street 1:292 GLADES RD STE 8
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-1368
Practice Address - Country:US
Practice Address - Phone:859-428-7862
Practice Address - Fax:859-999-7869
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1127069163WC0200X
KY3018471363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine