Provider Demographics
NPI:1790289155
Name:HUTCHINSON, DIANA MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:MARIE
Last Name:HUTCHINSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 THOMPSONVILLE LN
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:KY
Mailing Address - Zip Code:42262-8250
Mailing Address - Country:US
Mailing Address - Phone:270-632-6743
Mailing Address - Fax:
Practice Address - Street 1:105 ELK FORK RD
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:KY
Practice Address - Zip Code:42220-7218
Practice Address - Country:US
Practice Address - Phone:270-265-2574
Practice Address - Fax:270-265-3098
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012170363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100526980Medicaid