MEDICARE: MS. DIANNA PURDOM BARKER APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	2986P	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2986P	OTHER	KY	LICENSE
2	7545155	OTHER	KY	AETNA
3	0000000278302	OTHER		BS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316929664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DIANNA PURDOM BARKER APRN

Provider Business Mailing Address
First Line	:	333 S 3RD ST
Second Line	:	SUITE A
City	:	DANVILLE
State	:	KY
Zip	:	40422-2016
Country	:	US
Telephone Number	:	859-236-7712
Fax Number	:	859-236-7246

Provider Business Practice Location Address
First Line	:	333 S 3RD ST
Second Line	:	SUITE A
City	:	DANVILLE
State	:	KY
Zip	:	40422-2016
Country	:	US
Telephone Number	:	859-236-7712
Fax Number	:	859-236-7246

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	11/24/2015

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