Healthcare Provider Details

I. General information

NPI: 1528391570
Provider Name (Legal Business Name): DIANA L WILLIAMSON APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 12/29/2019
Certification Date: 12/29/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7238 W HIGHWAY 80
NANCY KY
42544-8752
US

IV. Provider business mailing address

PO BOX 100
NANCY KY
42544-0100
US

V. Phone/Fax

Practice location:
  • Phone: 606-636-4214
  • Fax: 606-636-4215
Mailing address:
  • Phone: 606-636-4214
  • Fax: 606-636-4215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6130
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: