Healthcare Provider Details

I. General information

NPI: 1609898741
Provider Name (Legal Business Name): DINAH M. CRAIN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DINAH M. SMITH ARNP

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 09/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 WALLACE AVE #105
LEITCHFIELD KY
42754-2404
US

IV. Provider business mailing address

2695 S JACKSON HWY
HORSE CAVE KY
42749-7035
US

V. Phone/Fax

Practice location:
  • Phone: 270-528-4114
  • Fax: 270-230-0712
Mailing address:
  • Phone: 270-528-3683
  • Fax: 270-528-3684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1059978
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: