Provider Demographics
NPI:1740419050
Name:BUSKIRK, DIANA M (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:M
Last Name:BUSKIRK
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-2050
Mailing Address - Country:US
Mailing Address - Phone:606-878-1961
Mailing Address - Fax:606-877-1958
Practice Address - Street 1:1675 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-2050
Practice Address - Country:US
Practice Address - Phone:606-878-1961
Practice Address - Fax:606-877-1958
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3220P363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health