Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 357938 | OH |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 3007520 | KY |
NPI | 1033468939 |
---|---|
Provider Name | Carla Dianne Dyer |
First Address | Ashland, KY 41105-0790 |
Second Address | Sandy Hook, KY 41171 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2012 |
Last Update Date | 14/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0074587 | (05) | OH |
3810030197 | (05) | WV |
7100226930 | (05) | KY |