Provider Demographics
NPI:1316929664
Name:BARKER, DIANNA PURDOM (APRN)
Entity type:Individual
Prefix:MS
First Name:DIANNA
Middle Name:PURDOM
Last Name:BARKER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:DIANNA
Other - Middle Name:M
Other - Last Name:HAMBLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:333 S 3RD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-2016
Mailing Address - Country:US
Mailing Address - Phone:859-236-7712
Mailing Address - Fax:859-236-7246
Practice Address - Street 1:333 S 3RD ST
Practice Address - Street 2:SUITE A
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-2016
Practice Address - Country:US
Practice Address - Phone:859-236-7712
Practice Address - Fax:859-236-7246
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2986P363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2986POtherLICENSE
KY7545155OtherAETNA
0000000278302OtherBS
KY78009057Medicaid
KY1284110Medicare PIN
KY2986POtherLICENSE