Healthcare Provider Details

I. General information

NPI: 1407598048
Provider Name (Legal Business Name): DIANA KATHLEEN BROSIUS MSN, APRN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 GLADES RD STE 8
BEREA KY
40403-1368
US

IV. Provider business mailing address

946A SOUTHERN HILLS DR
RICHMOND KY
40475-3410
US

V. Phone/Fax

Practice location:
  • Phone: 859-428-7862
  • Fax: 859-999-7869
Mailing address:
  • Phone: 859-582-9897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number1127069
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3018471
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: