Provider Demographics
NPI:1508869306
Name:RESS, DIANE (NP)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:RESS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-857-2066
Mailing Address - Fax:423-857-2070
Practice Address - Street 1:2033 MEADOWVIEW LN
Practice Address - Street 2:STE 200
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-7569
Practice Address - Country:US
Practice Address - Phone:423-857-2260
Practice Address - Fax:423-857-2261
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN5512363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010162971Medicaid
TN3700592Medicare UPIN
0281780001Medicare PIN
TN3640560Medicare UPIN
TNPENDINGMedicare ID - Type Unspecified
TN103I086169Medicare UPIN
0281780003Medicare PIN