Healthcare Provider Details

I. General information

NPI: 1417737396
Provider Name (Legal Business Name): KYLE S FOUCH APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2023
Last Update Date: 09/22/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5010 N STONE MILL RD
BLOOMINGTON IN
47408-9477
US

IV. Provider business mailing address

855 SOUTH COLLEGE MALL ROAD PMB 288
BLOOMINGTON IN
47401
US

V. Phone/Fax

Practice location:
  • Phone: 812-929-2193
  • Fax: 888-789-8394
Mailing address:
  • Phone: 219-512-5459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71014458A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number28248377A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: