Provider Demographics
NPI:1609898741
Name:CRAIN, DINAH M (ARNP)
Entity Type:Individual
Prefix:
First Name:DINAH
Middle Name:M
Last Name:CRAIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:DINAH
Other - Middle Name:M
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:2695 S JACKSON HWY
Mailing Address - Street 2:
Mailing Address - City:HORSE CAVE
Mailing Address - State:KY
Mailing Address - Zip Code:42749-7035
Mailing Address - Country:US
Mailing Address - Phone:270-528-3683
Mailing Address - Fax:270-528-3684
Practice Address - Street 1:912 WALLACE AVE
Practice Address - Street 2:#105
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-2404
Practice Address - Country:US
Practice Address - Phone:270-528-4114
Practice Address - Fax:270-230-0712
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1059978363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP03379Medicare UPIN
KY0259005Medicare PIN