MEDICARE: KATHERINE ANN BACK NP

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	363LA2200X	Adult Health Nurse Practitioner	71005150A	IN
2	363LA2200X	Adult Health Nurse Practitioner	28198239A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Q00416530	OTHER	IN	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1578964169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE ANN BACK NP

Provider Business Mailing Address
First Line	:	6101 BLUE LAGOON DR STE 200
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3168
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2902 W 86TH ST STE 220
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-2196
Country	:	US
Telephone Number	:	317-343-8607
Fax Number	:	877-473-0054

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

Provider Enumeration Date	:	09/15/2014
Last Update Date	:	03/04/2026

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Directions to “ KATHERINE ANN BACK NP” Practice Location

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