Healthcare Provider Details

I. General information

NPI: 1326004946
Provider Name (Legal Business Name): DIANA MAE BRATCHER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANA NICHOLS ARNP

II. Dates (important events)

Enumeration Date: 04/22/2006
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3470 BLAZER PKWY STE 200
LEXINGTON KY
40509-1887
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 859-277-3737
  • Fax: 859-277-3765
Mailing address:
  • Phone: 859-277-3737
  • Fax: 859-277-3765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3002015
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number3002015
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: