Provider Demographics
NPI:1528391570
Name:WILLIAMSON, DIANA L (APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:L
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:APRN, FNP-C
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 100
Mailing Address - Street 2:
Mailing Address - City:NANCY
Mailing Address - State:KY
Mailing Address - Zip Code:42544-0100
Mailing Address - Country:US
Mailing Address - Phone:606-636-4214
Mailing Address - Fax:606-636-4215
Practice Address - Street 1:7238 W HIGHWAY 80
Practice Address - Street 2:
Practice Address - City:NANCY
Practice Address - State:KY
Practice Address - Zip Code:42544-8752
Practice Address - Country:US
Practice Address - Phone:606-636-4214
Practice Address - Fax:606-636-4215
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2019-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6130363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100095720Medicaid