Provider Demographics
NPI:1669440723
Name:SMITH, DIANNA KAY (MSN, CNP, FNP, PMHNP)
Entity Type:Individual
Prefix:MS
First Name:DIANNA
Middle Name:KAY
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSN, CNP, FNP, PMHNP
Other - Prefix:MS
Other - First Name:DIANNA
Other - Middle Name:KAY
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:2538 WHEATON RD
Mailing Address - Street 2:
Mailing Address - City:BIDWELL
Mailing Address - State:OH
Mailing Address - Zip Code:45614-9348
Mailing Address - Country:US
Mailing Address - Phone:740-645-3491
Mailing Address - Fax:740-578-4821
Practice Address - Street 1:254 PINECREST DR
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1347
Practice Address - Country:US
Practice Address - Phone:740-578-4824
Practice Address - Fax:740-578-4821
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH06403363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2282444Medicaid
OHSMNP09184Medicare PIN
OHSMNP09186Medicare PIN
OHSMNP09185Medicare PIN