Provider Demographics
NPI:1710073945
Name:DIANA, GINA (ARNP)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:DIANA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:KIRCHNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-0432
Mailing Address - Country:US
Mailing Address - Phone:606-218-4762
Mailing Address - Fax:606-218-4562
Practice Address - Street 1:911 BYPASS ROAD
Practice Address - Street 2:5TH FLOOR ELLIOTT BUILDING
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1689
Practice Address - Country:US
Practice Address - Phone:606-218-2217
Practice Address - Fax:606-218-4944
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10562393594P363LA2200X
KY3003594363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health