Healthcare Provider Details

I. General information

NPI: 1265153795
Provider Name (Legal Business Name): KATHLEEN FRANCES MOLITOR AGCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 RONALD REAGAN PKWY
AVON IN
46123-7085
US

IV. Provider business mailing address

1982 STATEN CT
WESTFIELD IN
46074-9898
US

V. Phone/Fax

Practice location:
  • Phone: 317-217-3205
  • Fax:
Mailing address:
  • Phone: 317-514-3634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28208823A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number2022007883
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: