Healthcare Provider Details

I. General information

NPI: 1225444284
Provider Name (Legal Business Name): DIANNA M KINNIK-LEE CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 01/25/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 W BROAD ST
COLUMBUS OH
43228-1607
US

IV. Provider business mailing address

5350 FRANTZ RD
DUBLIN OH
43016-4259
US

V. Phone/Fax

Practice location:
  • Phone: 614-544-2058
  • Fax: 614-544-2444
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.16135-NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.232339-COA1
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: