Provider Demographics
NPI:1841297967
Name:STOTTS, DIANA R (CFNP, PHD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:R
Last Name:STOTTS
Suffix:
Gender:F
Credentials:CFNP, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CHATEAU GROVE LN
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-1626
Mailing Address - Country:US
Mailing Address - Phone:304-736-4000
Mailing Address - Fax:304-736-5690
Practice Address - Street 1:4 CHATEAU LN
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1627
Practice Address - Country:US
Practice Address - Phone:304-736-4000
Practice Address - Fax:304-736-5690
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV023663363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2105635Medicaid
WV0166777000Medicaid
WVSTNP01233Medicare PIN
OH2105635Medicaid