Healthcare Provider Details

I. General information

NPI: 1740760784
Provider Name (Legal Business Name): KAITLYN NEVILL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 W NATIONAL AVE
BRAZIL IN
47834-2502
US

IV. Provider business mailing address

503 W NATIONAL AVE
BRAZIL IN
47834-2502
US

V. Phone/Fax

Practice location:
  • Phone: 812-995-4197
  • Fax: 833-450-6291
Mailing address:
  • Phone: 812-995-4197
  • Fax: 833-450-6291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71008661A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: