Healthcare Provider Details

I. General information

NPI: 1669440723
Provider Name (Legal Business Name): DIANNA KAY SMITH MSN, CNP, FNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANNA KAY COX CNP

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 PINECREST DR
GALLIPOLIS OH
45631-1347
US

IV. Provider business mailing address

2538 WHEATON RD
BIDWELL OH
45614-9348
US

V. Phone/Fax

Practice location:
  • Phone: 740-578-4824
  • Fax: 740-578-4821
Mailing address:
  • Phone: 740-645-3491
  • Fax: 740-578-4821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number06403
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number06403
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: