Provider Demographics
NPI:1447341458
Name:GRABER, DIANNA K (CRNA)
Entity type:Individual
Prefix:MRS
First Name:DIANNA
Middle Name:K
Last Name:GRABER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:DIANNA
Other - Middle Name:K
Other - Last Name:CARPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2507 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001
Mailing Address - Country:US
Mailing Address - Phone:270-442-8228
Mailing Address - Fax:270-442-9566
Practice Address - Street 1:2501 KENTUCKY AVENUE
Practice Address - Street 2:WESTERN BAPTIST HOSPITAL
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003
Practice Address - Country:US
Practice Address - Phone:270-575-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1064190367500000X
TXAP139906367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY74007675Medicaid
KY74007675Medicaid